Colorectal stenting: an effective therapy for preoperative and palliative treatment.

Abstract

PURPOSE:

To demonstrate the effectiveness of preoperative and palliative colorectal stent placement in acute colonic obstruction.

METHODS:

Sixty-seven consecutive patients (mean age 67.3 years, range 25-93 years) with clinical and radiological signs of colonic obstruction were treated: 45 (67%) preoperatively and 22 (33%) with a palliative intent. In 59 patients (88%) the obstruction was malignant, while in 8 (12%) it was benign. A total of 73 enteric Wallstents were implanted under combined fluoroscopic/endoscopic guidance.

RESULTS:

Forty-five patients were treated preoperatively with a technical success rate of 84%, a clinical success rate of 83%, and a complication rate of 16%. Of the 38 patients who were successfully stented preoperatively, 36 (95%) underwent surgery 2-22 days (mean 7.2 days) after stent insertion. The improved general condition and adequate bowel cleansing allowed single-stage tumor resection and primary end-to-end anastomosis without complications in 31 cases (86% of all operations), while only 5 patients had colostomies. Stent placement was used as the final palliative treatment in 22 patients. The technical success rate was 95%, the clinical success rate 72%, and the complication rate relatively high at 67%, caused by reocclusion in most cases. After noninvasive secondary interventions (e.g., tube placement, second stenting, balloon dilatation) the secondary patency of stents was 71% and mean reported survival time after stent insertion was 92 days (range 10-285 days).

CONCLUSION:

Preoperative stent placement in acute colonic obstruction is minimally invasive and allows an elective one-stage surgery in most cases. Stent placement also proved a valuable alternative to avoid colostomy in palliation.

• Authors: Rahel S Jost, Res Jost, Erich Schoch, Brigit Brunner, Marco Decurtins, Christoph L Zollikofer
• Journal: Cardiovascular and interventional radiology (Cardiovasc Intervent Radiol) 2007 May-Jun Vol. 30 Issue 3 Pg. 433-40 ISSN: 0174-1551 [Print] United States
• PMID: 17225973 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Colectomy
• Colon (pathology)
• Colonic Diseases (diagnostic imaging, pathology, surgery)
• Colorectal Neoplasms (diagnostic imaging, pathology, surgery)
• Colostomy
• Female
• Humans
• Intestinal Obstruction (diagnostic imaging, pathology, surgery)
• Male
• Middle Aged
• Neoadjuvant Therapy
• Palliative Care
• Prosthesis Design
• Rectum (pathology)
• Retreatment
• Stents
• Tomography, X-Ray Computed
• Treatment Outcome