Management of acute malignant large-bowel obstruction with self-expanding metal stent

Purpose Colorectal stents are being used for palliation and as a “bridge to surgery” in obstructing colorectal carcinoma. The purpose of this study was to review our experience with self-expanding metal stents (SEMS) as the initial interventional approach in the management of acute malignant large-bowel obstruction. Methods Between February 2002 and August 2009, 93 patients underwent the insertion of a SEMS for an obstructing malignant lesion of the left-sided colon or rectum. Results In 66 patients, the stents were placed for palliation; whereas, in 27 patients they were placed as a bridge to surgery. Stent placement was technically successful in 92.5% (n = 86) of the patients, with a clinical success rate of 86% (n = 80). Three perforations occurred during stent placement, two were treated by an emergency Hartmann operation, and one by a colostomy. In the intention to treat by stent, the peri-interventional mortality was 6.5% (6/93). Stent migration was reported in three cases (3%), and stent obstruction occurred in 11 cases (12%). Of the 24 patients with stents successfully placed as a bridge to surgery, 22 underwent elective single-stage operations with no death or anastomotic complication. Conclusion Stent insertion provided an effective outcome in patients with malignant colonic obstruction as a palliative and preoperative therapy.