Colorectal stenting for management of acute malignant bowel obstruction in advanced colorectal cancer in Iran

Abstract

Introduction: Enteral stenting is used increasingly as a palliative treatment of gastrointestinal malignant or non-malignant obstructions. This aim of this study was to evaluate the role of endoscopic stent implantation for palliation of acute colorectal cancer obstruction in critical patients.

Methods: This study was performed prospectively with 8 patients suffering clinical manifestations of acute bowel obstruction with severe co-morbid diseases that caused them to be inoperable. They were treated by semi-elective stent insertion after primary resuscitation. Gentle dilation of stricture with balloon or buginage was performed under fluoroscopy and colonoscopy in gastrointestinal ward without complete preparation. Then an uncovered self-expanding metal stent was inserted over guide wire in the location of the tumor.

Results: Endoscopic stent implantation could be successfully performed in six patients. In early days after stent insertion; general condition of patients gradually improved, and symptoms of acute obstruction was relieved. In two of the cases stent was inserted with difficulty due to very tortuous and complex strictures. Complications of stenting in this study were very rare. Displacement of stent after successful insertion was not seen. Of our studied patients, two died after 2 months, one after 4 months and three of them after 7-8 months. The cause of death in these patients was advanced metastatic lesion in liver, lung, bone and severe underlying disease such as heart failure.

Conclusion: Endoscopic stent implantation seems to be an effective and safe palliative approach for management of emergency conditions of acute colonic obstruction in inoperable patients with advanced colorectal cancer.