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. |
