Fluoroscopically Guided Placement of Self-Expandable Metallic Stents and Stent-Grafts in the Treatment of Acute Malignant Colorectal Obstruction

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Abstract

PURPOSE:

To evaluate the technical feasibility and clinical effectiveness of fluoroscopically guided placement of self-expandable metallic stents and stent-grafts for acute malignant colorectal obstruction.

MATERIALS AND METHODS:

Radiologic images and clinical reports of 42 patients (22 men, 20 women; age range, 28-93 years; median age, 65.5 years) who underwent fluoroscopically guided colorectal stent insertion without endoscopic assistance for acute malignant obstruction were reviewed retrospectively. Eighteen patients received bare stents as a bridge to surgery. Twenty-four patients received 27 insertions of either a bare stent (n= 15) or a stent-graft (n= 12) for palliation. The obstruction was located in the rectum (n= 8), sigmoid (n= 17), descending colon (n= 8), splenic flexure (n= 3), and transverse colon (n= 6).

RESULTS:

Clinical success, defined as more than 50% dilatation of the stent with subsequent symptomatic improvement, was achieved in 41 of the 42 patients (98%). No major procedure-related complications occurred. Minor complications occurred in eight of the 45 procedures (18%). No perioperative mortalities occurred within 1 month after surgery. In the palliative group, the median stent patency was 62 days (range, 0-1,014 days). There was no statistically significant difference in stent patency between the bare stents (range, 0-855 days; median, 68 days) and stent-grafts (range, 1-1,014 days; median, 81 days).

CONCLUSIONS:

Fluoroscopically guided placement of self-expandable metallic stents and stent-grafts for the relief of acute malignant colorectal obstruction was technically feasible without endoscopic assistance—even in lesions proximal to the splenic flexure and transverse colon—and clinically effective in both bridge to surgery and palliative management.

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