Enteral stents for the management of malignant colorectal obstruction

Abstract

Colorectal cancer (CRC) is the 3rd most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient's quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may be used to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient's condition for curative surgical intervention. An overall complication rate (major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.

Endoscopic Self-Expandable Metallic Stent Insertion without Fluoroscopic Guidance Is Feasible and Safe for Acute Colonic Obstruction Caused by Colorectal Cancer

“…This successful colonic cannulation is similar to the nonradiation biliary cannulation [15,16]. The second advantage of the endoscope and fluoroscopy-combined technique is that the length of a stricture can be measured using the fluoroscopic monitor [8,13,14]. Based on CT scans, strictures were no longer than 10 cm, so commercially available stents 100 mm in length could be used for palliation of colonic obstructions [8].…”

“…However, most complete obstructions in CRC are complex and SEMS placement remains difficult and challenging. From the standpoint of safety and efficiency, stenting in CRC is usually performed by using a combined colonoscopic and fluoroscopic approach [4][5][6][7][8], and this hybrid procedure is widely accepted. Characterized by cannulation of strictures, the procedures of endoscopic stenting for colonic obstruction are similar with those of ERCP.…”

Placement of the Decompression Tube as a Bridge to Surgery for Acute Malignant Left-Sided Colonic Obstruction

“…[12][13][14] If patients Creation of stoma 0 Hospital stay after surgery (days) 11.1±1.4 (9)(10)(11)(12)(13)(14) Postoperative complications Wound infection 2…”

“…[12][13][14] The purpose of colonic stent insertion is colonic decompression, and then the tumor can be extirpated electively. [12][13][14] Ghazal et al 8 successfully placed colonic stent in 29 of 30 patients with malignant left-sided colonic obstruction. Afterward, all 29 patients successfully underwent elective tumor resection and primary anastomosis.…”

Long-Lasting Stent Placement in an Elderly Advanced Ovarian Cancer Patient

“…Placement of colonic stents in colorectal cancer patients presenting with malignant bowel obstruction was recently shown to be effective and safe and has now been proposed as the therapy of choice in these patients [9]. Quality of life is severely impaired in patients with bowel obstruction, and stent placement represents an alternative solution to avoid radical surgery [10].…”