Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases |
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Authors: | A J Small T M Young-Fadok T H Baron |
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Institution: | (1) Mayo Medical School, Rochester, MN, USA;(2) Division of Colon and Rectal Surgery, Mayo Clinic, Scottsdale, AZ, USA;(3) Division of Gastroenterology, Mayo Clinic, 200 First Street SW, Charlton 8, Rochester, MN 55905, USA |
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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.
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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Keywords: | Acute colonic obstruction Expandable metal stent Benign colorectal strictures SEMS |
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