Usefulness of Flexible Covered Stent in Malignant Colorectal Obstruction

Kang, Jee Hee; Kang, Sung Gwon; Kim, Hyung Jin; Noh, Hong Gi; Woo, Jae Hong; Suh, Chang Hae

Abstract

PURPOSE: To evaluate the usefulness of flexible covered stent in the treatment of acute colorectalobstruction secondary to colorectal carcinoma.
MATERIALS AND METHODS
Flexible covered stents were placed in 11patients with clinical and radiologic signs of acute colonic obstruction secondary to colorectal carcinoma. Thepurposes of stent insertion were pre-operative bowel preparation in seven patients and palliative treatment infour. A fistula was present in two;in one this was between the proximal jejunum and colon, and the other wasrectovaginal. The usefulness of stent insertion for the purpose of preoperative bowel preparation was evaluatedaccording to the feasability and status of bowel preparation, as decided by the operator. Palliative treatment forthe relief of symptoms of acute bowel obstruction was evaluated according to the number and amount of defecation,bowel dilatation in simple abdomen radiography, and the presence of complications. RESULT: Bowel preparation forthe purpose of preoperative bowel cleansing was easy in seven patients;the fecal materials remaining in the colonpresented no problems during surgery. In one of four patients palliative treatment involved a colostomy;this wasdue to recurrent stent obstruction by fecal materials after three months, and in two other patients there wasstent obstruction after two and five months, respectively. The stent in one of four patients who underwentpalliative treatment was removed because of stent migration three days after insertion;the stents in two patientswith fistulas covered the fistulas successfully. Complications after stent insertion were anal pain in threepatients, anal bleeding in three and stent migration in one.
CONCLUSION
The flexible covered stent was aneffective device for the relief of acute colonic obstruction secondary to malignant rectosigmoid neoplasia. Itallowed for single-stage operation and covered the fistula. We believe however that for further evaluation of theusefulness of this type of stent in long-term palliative treatment, a larger-scale study is needed.