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Malignant Colorectal Obstruction Treated by Means of Self-expanding Metallic Stents: Effectiveness before Surgery and in Palliation¹

¹ From the Departments of Radiology (F.C., A.E., G.S., J.V., I.B.M.) and Surgery (F.T.), Hospital General Universitario "Gregorio Marañón," Madrid, Spain. Received June 15, 1999; revision requested August 3; revision received November 23; accepted December 7. Address correspondence to F.C., Avda de Pio XII, 61, portal 8, 3° B, 28016 Madrid, Spain. (e-mail: echecamu@teleline.es).

PURPOSE: To determine the effectiveness and safety of metallic stents in the treatment of malignant colorectal obstruction before surgery and for palliation.

MATERIALS AND METHODS: Eighty patients with acute malignant colorectal obstruction presumed to be malignant were treated by means of implanting self-expanding metallic stents.

RESULTS: Stent placement was successful in 70 of the 80 patients and resolved bowel obstruction in 67 patients (96%). Two patients had colonic perforation and developed peritonitis 18 and 24 hours after stent placement; one patient died as a consequence. Thirty-three patients underwent elective surgery after 7 days ± 3 (SD; range, 4–10 days), and adequate tumoral coverage and cleansing of the colon were observed in all patients. Stent placement was used as final palliative treatment in another 35 patients. Patient follow-up lasted a mean of 138 days ± 93 (range, 36–334 days). The survival rate for the palliative group was 55% at 3 months, 44% at 6 months, and 25% at 9 months. The estimated primary stent patency rate was 91% at 3 and 6 months.

CONCLUSION: Management of colorectal obstruction by using metallic stents was effective and safe, although colonic perforation is a potential complication. In cases of palliation, the method may obviate palliative colostomy.

Index terms: Colon, interventional procedures, 75.1267, 75.1299 • Colon, stenosis or obstruction, 75.32 • Colon neoplasms, 75.32 • Interventional procedures, complications, 75.1267 • Stents and prostheses, 75.1299

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