Colorectal Stenting: An Effective Therapy for Preoperative and Palliative Treatment |
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Authors: | Rahel S Jost Res Jost Erich Schoch Brigit Brunner Marco Decurtins Christoph L Zollikofer |
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Institution: | (1) Department of Radiology, Kantonsspital Winterthur, Brauersstrasse 15, 8401 Winterthur, Switzerland;(2) Department of Internal Medicine, Section of Gastroenterology, Kantonsspital Winterthur, Brauersstrasse 15, 8401 Winterthur, Switzerland;(3) Department of Surgery, Kantonsspital Winterthur, Brauersstrasse 15, 8401 Winterthur, Switzerland |
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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. |
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Keywords: | Colorectal stenosis or obstruction Colorectal stent Endoscopy Palliative Preoperative |
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