2012, Number 6
PDF size: 212.24 Kb.
ABSTRACTBackground: in emergency surgery, colorectal mortality is very high compared with elective surgery. An alternative is placement of endoscopic stents to correct the bowel obstruction and then allow elective surgery. Moreover, it is possible to use stents in the palliative treatment of patients at high surgical risk or with unresecable tumors.
The aim of this study is to evaluate the rates of technical and clinical success and complications colorectal stents placement over the past 5 years.
Methods: retrospective study of 33 patients in which stents were placed since 2006 to 2011. Variables were analyzed: 1) the indication (palliation or "bridge to surgery"), 2) rates of technical success and clinical success, and 3) complications (perforation, migration, bleeding, and reocclusion).
Results: in 24 patients the prosthesis was placed as a palliative treatment (72.7%) and in 9 cases as a "bridge to surgery". The technical success rate was 87.87% and 82.14% clinical success. There were five cases of bowel perforation with high pneumoperitoneum and a case of microperforation (18.1%). 5 patients had reocclusion (17.2%); there were 3 and 4 bleeding and migration. Three patients died within 24 hours after endoscopic treatment. In 9 cases of "bridge to surgery," Technical success was 100% and 77% clinical. One patient required emergency surgery due to migration of the prosthesis and reocclusion and other colonic perforation.
Conclusions: endoscopic treatment is a good option as a transitional step to elective surgery or palliative treatment. But serious complications such as perforation or reocclusion should be considered.
Mulcahy HE, Skelly MM, Husain A, O'Donoghue DP. Long-term outcome following curative surgery for malignant largo bowel obstruccion. Br J Surg 1996;83(1):46-50.
Dohmoto M. New method: endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Dig 1991;3:1507-1512.
Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled Analysis of the Efficacy and Safety of Self-Expanding Metal Stenting in Malignant Colorectal Obstruction. Am J Gastroenterol 2004;99:2051-2057.
Tilney HS, Lovegrove RE, Purkayastha S, Sains PS, Weston-Petrides GK, Darzi AW, et al. Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 2007;21(2):225-233.
Meisner S, González-Huix F, Vandervoort JG, Goldberg P, Casellas JA, Roncero O, et al. Self-expandable metal stents for relieving malignant colorectal obstruction: short-term safety and efficacy within 30 days of stent procedure in 447 patients. Gastrointest Endosc 2011;74(4):876-884.
Khot UP, Lang AW, Murali K, Parker MMC. Systematic review of the efficacy and safety of colorectal stents. Br J Surg 2002;89(9):1096-1102.
Tsurumaru D, Hidaka H, Okada S, Sakoguchi T, Matsuda H, Matsumata T, et al. Self expandable metallic stents as palliative treatment for malignant colorectal obstruction. Abdom Imaging 2007;32(5):619-623.
Breitenstein S, Rickenbacher A, Berdajs D, Puhan M, Clavien PA, Demartines N. Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction. Br J Surg 2007;94(12):1451-1460.
Sayda Y, Sumiyama Y, Nagao J, Uramatsu M. Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 2003;46(10 Suppl):S44-49.
van Hooft JE, Bemelman WA, Oldenburg B, Marinelli AW, Holzik MFL, Grubben MJ, et al. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol 2011;12(4):344-352.
Fernández-Esparrach G, Bordas JM, Giráldez MD, Ginès A, Pellisé M, Sendino O, et al. Severe Complications Limit Long-Term Clinical Success of Self-Expanding Metal Stents in Patients With Obstructive Colorectal Cancer. Am J Gastroenterol 2010;105(5):1087-1093.
Pirlet IA, Slim K, Kwiatkowski F, Michot F, Millat BL. Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc 2011;25(6):1814-1821.
Sagar J. Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev 2011;9(11):CD007378.
Tan CJ, Dasari BV, Gardiner K. Systematic review and meta-analysis of Randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction. Br J Surg 2012;99(4):469-476.
Tominaga K, Maetani I, Sato K, Shigoka H, Omuta S, Ito S, et al. Favorable Long-term Clinical Outcome of Uncovered D-Weave Stent Placement as Definitive Palliative Treatment for Malignant Colorectal Obstruction. Dis Colon Rectum 2012;55(9):983-989.
Suh JP, Kim SW, Cho YK, Park JM, Lee IS, Choi MG, et al. Effectiveness of stent placement for palliative treatment in malignant colorectal obstruction and predictive factors for stent occlusion. Surg Endosc 2010;24(2):400-406.
Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc 2010;71(3):560-572.
Frago R, Kreisler E, Biondo S, Alba E, Dominguez J, Golda T, et al. Complications of distal intestinal occlusion treatment with endoluminal implants. Cir Esp 2011;89(7):448-455.