Interventional management of malignant colorectal obstruction: use of covered and uncovered stents

Abstract

Objective: We wanted to evaluate usefulness of uncovered stent in comparison with covered stent for the palliative treatment of malignant colorectal obstruction.

Materials and methods: Covered (n = 52, type 1 and type 2) and uncovered (n = 22, type 3) stents were placed in 74 patients with malignant colorectal obstruction. Stent insertion was performed for palliative treatment in 37 patients (covered stent: n = 23 and uncovered stent: n = 14). In the palliative group, the data on the success of the procedure, the stent patency and the complications between the two groups (covered versus uncovered stents) were compared.

Results: The technical success rate was 89% (33/37). Symptomatic improvement was achieved in 86% (18/21) of the covered stent group and in 92% (11/12) of the uncovered stent group patients. The period of follow-up ranged from three to 319 days (mean period: 116+/-85 days). The mean period of stent patency was 157+/-33 days in the covered stent group and 165+/-25 days in the uncovered stent group. In the covered stent group, stent migration (n = 11), stent fracture (n = 2) and poor expansion of the stent (n = 2) were noted. In the uncovered stent group, tumor ingrowth into the stents (n = 3) was noted.

Conclusion: Self-expanding metallic stents are effective for relieving malignant colorectal obstruction. The rate of complications is lower in the uncovered stent group than in the covered stent group.

Fig. 1

Type 1 (A), type 2 (B) and type 3 (C) stents. To prevention migration, two-thirds of the proximal part of the type 2 stent is not covered (arrowheads).

Fig. 2

Stent fracture of the type 2 stent in a 64-year-old patient. 180 days after stent insertion, the stent broke between the proximal end and the body (arrows).

Fig. 3

Inadequate expansion of the type 2 stent in a 60-year-old patient. Seven days after insertion, inadequate expansion of the stent was noted.

Fig. 4

Tumor ingrowth of the type 3 stent in a 65-year-old patient. 135 days after stent insertion, tumor ingrowth on the CT scan was seen (arrows). No symptomatic bowel obstruction was noted until the patient's death.