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Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases

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Abstract

Background

Self-expanding metal stents (SEMS) are an established treatment for palliation of malignant colorectal strictures and as a bridge to surgery for acute malignant colonic obstruction. Patients with benign colonic strictures may benefit from stent placement, but little data exist for this indication.

Methods

All cases of colonic stent placement identified from a prospectively collected gastrointestinal database from April 1999 to August 2006 were reviewed. During the study period, 23 patients with benign obstructive disease underwent endoscopic SEMS placement. The etiologies of the stricture were diverticular/inflammatory (n = 16), postsurgical anastomotic (n = 3), radiation-induced (n = 3), and Crohn’s (n = 1) disease. All strictures were located in the left colon. Five patients had an associated colonic fistula. Uncovered Enteral Wallstents or Ultraflex Precision Colonic stents (Boston Scientific) were endoscopically placed in all but one patient.

Results

Stent placement was technically successful for all 23 patients, and obstruction was relieved for 22 patients (95%). Major complications occurred in 38% of the patients including migration (n = 2), reobstruction (n = 4), and perforation (n = 2). Of these major complications, 87% occurred after 7 days. Four patients did not undergo an operation. Of the 19 patients who underwent planned surgical resection, 16 were successfully decompressed and converted from an emergent operation to an elective one with a median time to surgical resection of 12 days (range, 2 days to 18 months). Surgery was delayed more than 30 days after stent placement for six of these patients. Of the 19 patients who underwent a colectomy, 8 (42%) did not need a stoma after stent insertion.

Conclusions

SEMS can effectively decompress high-grade, benign colonic obstruction, thereby allowing elective surgery. The use of SEMS can offer medium-term symptom relief for benign colorectal strictures, but this approach is associated with a high rate of delayed complications. Thus, if elective surgery is planned, data from this small study suggest that it should be performed within 7 days of stent placement.

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References

  1. Baron TH, Rey JF, Spinelli P (2002) Expandable metal stent placement for malignant colorectal obstruction. Endoscopy 34:823–830

    Article  CAS  PubMed  Google Scholar 

  2. Baron TH, Dean PA, Yates MR 3rd, Canon C, Koehler RE (1998) Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc 47:7–286

    Article  Google Scholar 

  3. Meisner S, Hensler M, Knop FK, West F, Wille-Jorgensen P (2004) Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center. Dis Colon Rectum 47:444–450

    Article  PubMed  Google Scholar 

  4. Suzuki N, Saunders BP, Thomas-Gibson S, Akle C, Marshall M, Halligan S (2004) Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Dis Colon Rectum 47:1201–1207

    Article  PubMed  Google Scholar 

  5. Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M (2004) Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99:2051–2057

    Article  PubMed  Google Scholar 

  6. Baron TH (2005) Colonic stenting: technique, technology, and outcomes for malignant and benign disease. Gastrointest Endosc Clin North Am 15:757–771

    Article  Google Scholar 

  7. Baron TH (2003) Colorectal stents. Tech Gastrointest Endosc 5:182–190

    Article  Google Scholar 

  8. Deans GT, Krukowski ZH, Irwin ST (1994) Malignant obstruction of the left colon. Br J Surg 81:10–16

    Google Scholar 

  9. Tang E, Davis J, Silberman H (1995) Bowel obstruction in cancer patients. Arch Surg 130:832–836

    CAS  PubMed  Google Scholar 

  10. Bhardwaj R, Parker MC (2003) Palliative therapy of colorectal carcinoma: stent or surgery? Colorectal Dis 5:518–521

    Article  CAS  PubMed  Google Scholar 

  11. Paul L, Pinto I, Gomez H, Fernandez-Lobato R, Moyano E (2002) Metallic stents in the treatment of benign diseases of the colon: preliminary experience in 10 cases. Radiology 223:715–722

    Article  PubMed  Google Scholar 

  12. Law WL, Choi HK, Chu KW, Tung HM (2002) Radiation stricture of rectosigmoid treated with self-expanding metallic stent. Surg Endosc 16:1106–1107

    Article  CAS  PubMed  Google Scholar 

  13. Dormann AJ, Deppe H, Wigginghaus B (2001) Self-expanding metallic stents for continuous dilatation of benign stenoses in gastrointestinal tract: first results of long-term follow-up in interim stent application in pyloric and colonic obstructions. Z Gastroenterol 39:957–960

    Article  CAS  PubMed  Google Scholar 

  14. King DW, Lubowski DZ, Armstrong AS (1990) Sigmoid stricture at colonoscopy: an indication for surgery. Int J Colorectal Dis 5:161–163

    Article  CAS  PubMed  Google Scholar 

  15. Rutgeerts P, Geboes K, Vantrappen G, Kerremans R, Coenegrachts JL, Coremans G (1984) Natural history of recurrent Crohn’s disease at the ileocolonic anastomosis after curative surgery. Gut 25:665–672

    Article  CAS  PubMed  Google Scholar 

  16. Schlegel RD, Dehni N, Parc R, Caplin S, Tiret E (2001) Results of reoperations in colorectal anastomotic strictures. Dis Colon Rectum 44:1464–1468

    Article  CAS  PubMed  Google Scholar 

  17. Constantinides VA, Tekkis PP, Athanasiou T, Aziz O, Purkayastha S, Remzi FH, Fazio VW, Aydin N, Darzi A, Senapati A (2006) Primary resection with anastomosis vs Hartmann’s procedure in nonelective surgery for acute colonic diverticulitis: a systematic review. Dis Colon Rectum 49:966–981

    Article  PubMed  Google Scholar 

  18. Harris GJ, Senagore AJ, Lavery IC, Fazio VW (2001) The management of neoplastic colorectal obstruction with colonic endolumenal stenting devices. Am J Surg 181:499–506

    Article  CAS  PubMed  Google Scholar 

  19. Baxter NN, Novotny PJ, Jacobson T, Maidl LJ, Sloan J, Young-Fadok TM (2006) A stoma quality of life scale. Dis Colon Rectum 49:205–212

    Article  PubMed  Google Scholar 

  20. Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD (1999) Quality of life in stoma patients. Dis Colon Rectum 42:1569–1574

    Article  CAS  PubMed  Google Scholar 

  21. Park JJ, Del Pino A, Orsay CP, Nelson RL, Pearl RK, Cintron JR, Abcarian H (1999) Stoma complications: the Cook County Hospital experience. Dis Colon Rectum 42:1575–1580

    Article  CAS  PubMed  Google Scholar 

  22. Carne PW, Frye JN, Robertson GM, Frizelle FA (2004) Stents or open operation for palliation of colorectal cancer: a retrospective, cohort study of perioperative outcome and long-term survival. Dis Colon Rectum 47:1455–1461

    Article  PubMed  Google Scholar 

  23. Goyal A, Schein M (2001) Current practices in left-sided colonic emergencies: a survey of U.S. gastrointestinal surgeons. Dig Surg 18:399–402

    Article  CAS  PubMed  Google Scholar 

  24. Ng KC, Law WL, Lee YM, Choi HK, Seto CL, Ho JW (2006) Self-expanding metallic stent as a bridge to surgery versus emergency resection for obstructing left-sided colorectal cancer: a case-matched study. J Gastrointest Surg 10:798–803

    Article  PubMed  Google Scholar 

  25. Martinez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Deballon P, Moreno-Azcoita M (2002) Self-expandable stent before elective surgery vs emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum 45:401–406

    Article  PubMed  Google Scholar 

  26. Law WL, Choi HK, Chu KW (2003) Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg 90:1429–1433

    Article  CAS  PubMed  Google Scholar 

  27. Binkert CA, Ledermann H, Jost R, Saurenmann P, Decurtins M, Zollikofer CL (1998) Acute colonic obstruction: clinical aspects and cost effectiveness of preoperative and palliative treatment with self-expanding metallic stents: a preliminary report. Radiology 206:199–204

    CAS  PubMed  Google Scholar 

  28. Adler DG, Baron TH (2002) Endoscopic palliation of colorectal cancer. Hematol Oncol Clin North Am 16:1015–1029

    Article  PubMed  Google Scholar 

  29. Yates MR III, Baron TH (1999) Treatment of a radiation-induced sigmoid stricture with an expandable metal stent. Gastrointest Endosc 50:422–426

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Mayo Medical School, Rochester, MN, USA

    A. J. Small

  2. Division of Colon and Rectal Surgery, Mayo Clinic, Scottsdale, AZ, USA

    T. M. Young-Fadok

  3. Division of Gastroenterology, Mayo Clinic, 200 First Street SW, Charlton 8, Rochester, MN, 55905, USA

    T. H. Baron

Authors
  1. A. J. Small
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  2. T. M. Young-Fadok
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  3. T. H. Baron
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Corresponding author

Correspondence to T. H. Baron.

Additional information

Podium presentation at the annual meeting of the Society of American Gastrointestinal and Esophageal Surgeons (SAGES), 18–22 April 2007 at Las Vegas, NV, USA

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Small, A.J., Young-Fadok, T.M. & Baron, T.H. Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases. Surg Endosc 22, 454–462 (2008). https://doi.org/10.1007/s00464-007-9453-z

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