Self-expandable Metallic Stent for the Management of Acute Malignant Large-bowel Obstruction

ABSTRACT

PURPOSE: The purpose of this study was to review our experience with the use of self-expandable metallic stents as the initial interventional management for acute malignant large-bowel obstruction. METHODS: The records of 35 patients who underwent placement of a colonic stent for acute malignant obstruction at our institution between January 2003 and December 2004 were reviewed. RESULTS: Stents were placed for palliation in 19 patients and as bridge to surgery in 16 patients. Technical success of stent placement was achieved in all patients (100%), but clinical failure occurred in two patients due to limited expansion of the metallic stent. One of them who had clinical failure underwent an emergency operation, and the other needed no further procedure because of his death. Complications occurred in 4 patients (12%), including one pelvic abscess associated with colon perforation, two minor bleedings, and one anal pain. All the patients in the bridge-to-surgery group underwent an elective colon resection without stoma. In the palliative group, stent reocclusion was observed in three patients during the follow-up (median 65 days; range 27~440 days), two of which were managed by reinsertion of a stent. In the remaining patients, the stent was patent until death or the last follow up date (median 65 days). CONCLUSIONS: Placement of a self-expandable metallic stent is a safe and effective procedure for immediate decompression of acute malignant large-bowel obstruction. It provides a chance of elective surgery for patients with resectable disease, as well as relief of symptoms for those with unresectable disease.