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Colonic stents allow elective surgery for malignant large-bowel obstruction

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – A large multicenter study confirms that placement of self-expanding metal stents in the colon in cases of malignant colorectal obstruction restores bowel transit and provides a bridge to elective surgery in most instances, thus avoiding emergency surgery with stoma creation.

“Moreover, the use of this stent is safe and associated with an acceptable complication rate,” note the authors of the report in the American Journal of Gastroenterology online November 15.

Dr. J. Jimenez-Perez, at the Hospital de Navarra in Pamplona, Spain, and colleagues note that urgent surgery for large-bowel obstruction by a colorectal tumor very often includes a colostomy and is associated with high morbidity and mortality rates. Several studies, they point out, have reported on the efficacy and safety of self-expanding metal stents (SEMSs) as a bridge to surgery for patients with potentially resectable colorectal cancer.

The current study looks at the use of the WallFlex colonic stent (Boston Scientific) in 39 centers in 13 countries. A total of 182 patients were referred for stent placement as a bridge to surgery. At initial staging, 86% of patients had localized colorectal cancer with no metastases.

The stent was successfully deployed in 177 of 181 assessable patients (98%), the report indicates. Clinical success, based on passage of stool without stent-related complications, could be ascertained in150 patients and was achieved in 141 of them (94%).

Major procedural complications included 3 cases of perforation, persistent obstruction in 2 patients, and persistent bleeding in 1 case. Post-procedural complications occurred in 7 patients: 2 cases of stent migration, 2 cases of perforation, 1 instances of persistent obstruction, and 2 stent occlusions caused by fecal impaction.

The overall complication rate was 7.8%, the investigators report.

Among the enrolled patients, 157 underwent surgery – 7 on an emergency basis, and 150 electively. In the elective surgery group, stoma creation because of difficulties in performing a primary anastomosis was necessary in only 9 instances, Dr. Jimenez-Perez and colleagues note.

They conclude, “Colonic SEMSs are effective in patients with acute malignant colonic obstruction as a bridge-to-surgery treatment, restoring luminal patency and allowing elective surgical resection with primary anastomosis.”

Reference:

Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

Am J Gastroenterol 2011.