Abstract

CASTANO LLANO, Rodrigo et al. Current management of malignant and benign colorrectal obstruction: big, short or without incisions. Rev Col Gastroenterol [online]. 2008, vol.23, n.1, pp.57-66. ISSN 0120-9957.

Background: The use of metal autoexpandable stents in acute colorectal obstruction can be in three scenes: with palliative character, like a bridge to facilitate a future operation of unique and definitive character and finally in the benign pathology. We describe in this descriptive series with prospective follow-up the results of the use of colorectal stents in these three situations. Materials and methods: The positioning of 22 stents was analyzed in prospective form in 20 patients (11 men 55%), between June of 2003 and September of 2007. The age average was 71 years (rank of 46 to 91 years) the study was made with a previous preparation with rectal enemas and under sedation with Midazolam more Meperidina. Malignant obstruction was present in 16 patients and benign obstruction in 4 patients. The benign stenoses included ischemic (n=1), radiation (n=1) and anastomotic (n=2). All the patients with malignant pathology were attended with manifestations of acute colorectal occlusion. Results: Stents were used for palliation (8 patients), preoperative (8 patients) and benign obstruction (3 patients) Three patients required two stents by migration and in another one the location of tumor (descending colon) did not allow to release a peranal stent. Two obstructions (10%), two perforations (10%) and four migrations (20%) occurred. In more proximal stenoses through the scope stents (4 patients) were used and in rectosigmoid obstructions peranal stents produced locally were used. Clinical exit was 90%, there was one failure to place peranal stents in descending colon and one perforation, the patient didn´t accept surgery and die. Patients treated with palliative intention have had a survival average of 8 months and do not required colostomy. All the patients with benign stenoses were treated successfully with the application of the stent avoiding a definitive colostomy. Conclusions: The use of stents as a palliative procedure or a bridge to surgery is associated with low morbidity, allows for bowel preparation, and thus avoids the need for a temporary or definitive colostomy. Long-term patency suggests that stents may allow for the avoidance of an operation in patients with metastatic disease and further defines their role in the palliation of malignant obstruction and its application in benign pathology is equally encouraging. Further prospective randomized studies are necessary to fully elucidate the use of stents in the management of colorectal cancer and benign colorectal obstructions.

Keywords : Colorectal cancer; Bowel obstruction; colorectal surgery; colonoscopy; Colonic stent.

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