Malignant colonic obstruction due to extrinsic tumor: Palliative treatmentwith a self-expanding nitinol stent

OBJECTIVE. The purpose of this study was to evaluate the usefulness of self -expanding nitinol stents for palliative treatment of malignant colorectal obstruction caused by unresectable extrinsic tumor, colorectal metastasis, or peritoneal seeding. SUBJECTS AND METHODS. One covered stent and 10 uncovered stents were deploy ed in eight patients with colorectal obstruction due to extrinsic tumor und er fluoroscopic guidance. The sites of obstruction were located in the rect um (n = 5), in the rectosigmoid colon (n = 2), and from the transverse colo n to the descending colon (n = 1). Clinical usefulness and complications we re analyzed. RESULTS. Stents were placed successfully in all patients. Minor modificatio ns of the delivery system were required in the tortuous rectosigmoid and lo wer rectum strictures. Symptoms of obstruction were initially resolved in a ll but one patient. In that patient, the presence of other points of obstru ction was suspected. Bowel obstruction recurred in two patients: one obstru ction was due to migration of a covered stent 4 days after the procedure, a nd the other obstruction was due to peritoneal seeding 33 days after the pr ocedure. Both required colostomy or ileostomy. All patients died 12-111 day s after stent placement (mean, 56 days). In five patients (63%), colonic ob struction was palliated by placing a stent until the patients' death betwee n 39 and 111 days after stent placement (mean, 62 days). Six complications occurred in four patients and included stent migration (n = 1), anal bleedi ng (n = 2), anal pain that required analgesia (n = 1), and fever (n = 2). CONCLUSION. This self-expandable nitinol stent adequately palliated 63% of patients with colonic obstruction due to extrinsic tumor in this small seri es. Patient selection is very important to the success of this treatment.