Stent Use in Emergency Treatment of Malignant Colonic Obstruction

Abstract

Background: In previous studies, the outcome of stent use in malignant colonic obstruction patients widely varies. We aim to present the outcome of our patients who have undergone colonic stenting in malignant colonic obstruction as a bridge or conservative therapy in line with the literature. Materials and Method: We have retrospectively reviewed patient records in surgical endoscopy clinic of our hospital. The subjects were patients who had a diagnosis of colon malignancy between 2012-2018 and had undergone a self-expandable stent. Stenting was done as a bridge to surgery in resectable colorectal tumors or for palliation in colonic obstructions due to inoperable colorectal malign disease. Clinical success was defined as resolution of obstructive symptoms and immediate decompression of the bowels proven by the passage of stool and gas in 24 hr. Results: Twenty patients were included in the study. 14 (70%) patients were male, and 6 (30%) female, mean age was 61.4±22.6 years. Right colon 1 (5%), hepatic flexure 5 (25%), splenic flexure 1 (5%), sigmoid colon 7(35%), recto-sigmoid 2 (10%), upper rectum 4 (20%) stenting was performed in terms of location. In 11 of the patients (55%), the tumor was considered resectable. After the emergency condition of the patients was improved by stenting, they were ready for elective curative surgery. In nine (45%) patients, the tumor was unresectable. In these patients, stenting was ensued by oncologic follow-up. Stent migration after the procedure 3 (15%), stent remaining at distal during the procedure 2 (10%), re-obstruction after the procedure due to tumor invasion 2 (10%), inadequate expansion of the stent 1(5%) and perforation 1 (5%) were observed in patients. Conclusion: Stenting as a bridge or conservative therapy in malignant colonic obstruction by skilled surgeon increases success rates of one-stage operation significantly and increases the quality of life by decreasing the rates of a permanent stoma and wound infections.