Covered metal stents for management of inoperable malignant colorectal strictures

Background: Metal stents have been reported as an effective alternative to surgery for the palliation of patients with colorectal neoplastic obstructi on. Because most of the published series describe the use of uncovered sten ts, the purpose of our study was to prospectively evaluate the effectivenes s, feasibility, safety, and outcome of covered stents for the palliative tr eatment of malignant colorectal strictures. Methods: Sixteen patients with advanced distal colorectal cancer underwent placement of 10 and 12 cm long, 23 mm diameter covered stents under fluoros copic and endoscopic control. Clinical and endoscopic follow-up was schedul ed at 3- to 6-week intervals. Results: Stent insertion was successful in 15 of 16 patients (93%). Perfora tion occurred in one patient during stent placement requiring colostomy. Re lief of bower obstruction was documented in all successfully treated patien ts. The median follow-up was 21 weeks (range 1 to 46). No recurrence of obs truction was observed during the follow-up period. Stent migration occurred in 2 patients, 7 and 21 days after stent placement. Conclusions: Covered stents may provide safe and effective palliation of pa tients with malignant rectosigmoid strictures. Prolonged luminal patency an d sealing of fistulous tracts are potential advantages of covered versus un covered stents in the palliative treatment of colorectal malignancies.