Endoluminal Colonic Wall Stents for the Management of Malignant Recto-Sigmoid Obstruction
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Aim of the work: A prospective study to assess the applicability and efficacy of endoluminal colonic wall stents (ECWSs) in the management of large bowel obstruction (LBO). Patients: Twelve consecutive patients with malignant large bowel obstruction without peritonitis were subjected to placement of Endoscopic Colonic Wall Stent under endoscopic and fluoroscopic guidance. Main outcome measures the success rat:. in ECWS placement, the efficacy in decompressing the obstruction and the patency rate of the ECWS. Results: Successful placement of ECWSs was obtainable in II of 12 patients. Once placed, all 11 patients achieved immediate decompression of their recto-sigmoid obstruction. Nine patients had malignant obstructions associated with distant spread of disease. Among those with malignant obstruction, 6 patients had successful and lasting palliation without colostomy, 4 patients underwent 1- stage resection 1 month later with no evidence of obstruction and 1 patient could not be stented so diversion was done. One patient required a second ECWS secondary to recurrence of obstruction after stent migration and has continued palliation of his stage 4 rectal cancer for the last 11 months. No other complications were encountered. Conclusions: Urgent surgery with colostomy for rectosigmoid obstruction was avoided in 11 of 12 patients because of successful placement of ECWSs. We believe that endoscopic colonic stenting is safe, effective and lasting and should be considered as initial non-operative management in all patients seen with recto-sigmoid obstruction in the absence of peritonitis.