Background: Colonic stenting may serve as a bridge to surgery. Alternatively, in patients who are not candidates for surgery, colonic stenting may be performed for palliation. The aim of this prospective study was to evaluate the efficacy and safety of the new Wallflex™ colonic stents for acute bowel obstruction due to primary or recurrent colonic adenocarcinoma. Methods: from May 2004 to September 2006, patients with malignant large bowel occlusion were included in the study. Study was approved by the EC and patients gave informed consent. Exclusion criteria consisted of: benign stricture; perforated colon; extrinsic compressive tumor; concurrent radiotherapy for the colorectal stricture or treatment with an investigational drug or device within the preceding 4 weeks; placement of another metal stent for the same stricture. The presence of large bowel obstruction was confirmed by erect and supine abdominal X-rays and CT scan. Results: SEMS insertion was performed in 40 consecutive patients (17 females, 23 males, mean age 72.2 years with a range of 53 to 92 years). Technical and clinical success was obtained in 36 of 40 patients (92,5%). Failures were due to: stent misplacement; no expansion of the stent; impossibility to pass through the stricture. The distribution of malignant stenosis was as follows: rectum (n = 7, 17.5%), sigmoid colon (n = 18, 45%), descending colon (n = 9, 22.5%), splenic flexure (n = 2, 5%), transverse colon (n = 2, 5%) and hepatic flexure (n = 2, 5%). Colonic stenting was performed as bridge to surgery in 18 patients (45%) and as palliative treatment in 22 patients (55%). Early complications (within 1 week after SEMS placement) occurred in 2 patients: one colon perforation and one stent occlusion for stool impaction. Long-term complications occurred in 6 patients: 1 stent occlusion for fecal impaction, 2 for tumor ingrowth and 1 for tumor overgrowth and 1 rectal bleeding. The mean time between stent placement and surgery was 5.2 days (range, 2-12). There were not surgery complications. At the end of the follow-up period among patients treated for palliation 15 died with a median survival rate of 163 days (range 13 days-309 days) and seven were alive. Conclusions: The new Wallflex colonic stent can be used effectively to manage patients presenting with large bowel obstruction. The use of stents as a “bridge to the elective surgery” allowed the intestinal preparation, general status restoration, and a one-stage operation with resection and primary reanastomosis.
De Caro, G., Repici, A., Comunale, S., Cennamo, V., Fabbri, C., Preatoni, P., et al. (2007). Treatment of acute malignant colorectal obstruction with Wallflex™ colonic stents:: A prospective study. GASTROINTESTINAL ENDOSCOPY, 65(5), AB283-AB283 [10.1016/j.gie.2007.03.1000].
Treatment of acute malignant colorectal obstruction with Wallflex™ colonic stents:: A prospective study
Fabbri, C;Pagano, N;
2007
Abstract
Background: Colonic stenting may serve as a bridge to surgery. Alternatively, in patients who are not candidates for surgery, colonic stenting may be performed for palliation. The aim of this prospective study was to evaluate the efficacy and safety of the new Wallflex™ colonic stents for acute bowel obstruction due to primary or recurrent colonic adenocarcinoma. Methods: from May 2004 to September 2006, patients with malignant large bowel occlusion were included in the study. Study was approved by the EC and patients gave informed consent. Exclusion criteria consisted of: benign stricture; perforated colon; extrinsic compressive tumor; concurrent radiotherapy for the colorectal stricture or treatment with an investigational drug or device within the preceding 4 weeks; placement of another metal stent for the same stricture. The presence of large bowel obstruction was confirmed by erect and supine abdominal X-rays and CT scan. Results: SEMS insertion was performed in 40 consecutive patients (17 females, 23 males, mean age 72.2 years with a range of 53 to 92 years). Technical and clinical success was obtained in 36 of 40 patients (92,5%). Failures were due to: stent misplacement; no expansion of the stent; impossibility to pass through the stricture. The distribution of malignant stenosis was as follows: rectum (n = 7, 17.5%), sigmoid colon (n = 18, 45%), descending colon (n = 9, 22.5%), splenic flexure (n = 2, 5%), transverse colon (n = 2, 5%) and hepatic flexure (n = 2, 5%). Colonic stenting was performed as bridge to surgery in 18 patients (45%) and as palliative treatment in 22 patients (55%). Early complications (within 1 week after SEMS placement) occurred in 2 patients: one colon perforation and one stent occlusion for stool impaction. Long-term complications occurred in 6 patients: 1 stent occlusion for fecal impaction, 2 for tumor ingrowth and 1 for tumor overgrowth and 1 rectal bleeding. The mean time between stent placement and surgery was 5.2 days (range, 2-12). There were not surgery complications. At the end of the follow-up period among patients treated for palliation 15 died with a median survival rate of 163 days (range 13 days-309 days) and seven were alive. Conclusions: The new Wallflex colonic stent can be used effectively to manage patients presenting with large bowel obstruction. The use of stents as a “bridge to the elective surgery” allowed the intestinal preparation, general status restoration, and a one-stage operation with resection and primary reanastomosis.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
