Fluoroscopic Management of Complications after Colorectal Stent Placement

Abstract

Colorectal self-expanding metal stents have been widely used as a bridge to surgery in patients with acute malignant colonic obstruction by allowing a single-stage operation, or as a definitive palliative procedure in patients with inoperable tumors. Colonic stents are placed under either fluoroscopic or combined endoscopic and fluoroscopic guidance, with similar technical-success and complication rates. Placement of colonic stents is a very safe procedure with a low procedure-related mortality rate, but serious complications can develop and reinterventions are not uncommon. Most of the complications can be treated by minimally invasive or conservative techniques, while surgical interventions are required for most patients with perforation. (Gut Liver 2010;4(Suppl. 1):S9-18)

Outcomes of Secondary Self-Expandable Metal Stents versus Surgery after Delayed Initial Palliative Stent Failure in Malignant Colorectal Obstruction

“…The highest was as at 51%, and although most of the complications were minor, the authors argued that SEMSs were an ineffective therapy [1]. Severe complications may occur in up to 10% of patients and consist of stent migration, perforation, and bleeding [10,13,31]. Other reports revealed that the migration rate was 22% [4], and the perforation rate was 4% [30].…”

Enteral stents: Complications and their management

“…16 Complications after colorectal stent placement are usually minor but severe life-threatening complications can develop any time after the procedure. 17 …”

“…Stent obstructions occur from 48 hours to 480 days after placement and treatments included laser therapies to ablate obstructing tissue, restenting, surgery, and colonic irrigation. 14,17 In most cases restenting provides a definitive solution. Covered stents have a lower incidence of tumor ingrowth, but technical difficulties during deployment due to larger delivery systems, and a higher incidence of stent migration, have precluded a wider acceptance of this type of stents in the colon.…”

“…Minor complications related to colon stent placement such as mild to moderate rectal bleeding, transient anorectal pain, temporary incontinence, and fecal impaction are common in many reports (Table 1). [16][17][18][19][20][21][22][23][24][25][26] Late complications related to SEMS mainly include re-obstruction and migration of the stent, and rarely perforation. Migration incidence varies from 4% to 26% and is one of the more frequent complications observed at early follow-up.…”

“…27 Perforation can also be related to stent migration with unresolved or recurrent bowel obstruction. 15,17 Perforations are almost always managed by emergency surgical exploration (65%). In some cases, limited perforations can be managed with bowel rest and broad spectrum antibiotics.…”