Palliative Treatment for Inoperable Malignant Colorectal Obstruction By Means of Self-Expanding Metalic Stent and Transanal Ileus Tube

Palliative Treatment for Inoperable Malignant Colorectal Obstruction By Means of Self-Expanding Metalic Stent and Transanal Ileus Tube Yamada Tomonori, Sasaki Makoto, Shimura Takaya, Oshima Tadayuki, Tanida Satoshi, Kataoka Hiromi, Joh Takashi Background and Aim: Self-expanding metalic stent (SEMS) have been used in the management of malignant colorectal obstruction as an alternative to palliative surgery. Because most of the published series describe the stenting of the left-sided colon and the use of uncovered stents, the aims of our study are to prospectively evaluate the efficacy, safety, and outcome of covered and uncovered SEMSs for the palliative treatment of malignant strictures in the rectum to the distal ascending colon. Methods: 21 patients (10 males, 11 females, median age 73 years old with a range of 52 to 93 years) with inoperable malignant colorectal obstruction underwent placements of SEMS under fluoroscopic and endoscopic control. Seventeen patients had primary colorectal cancers, 2 had recurrent colonic cancers, 1 had ovarian cancer and 1 had bladder cancer. Before stenting, total colorectal obstructions as defined, if there was no passage of gas and feces, were adequately decompressed with the transanal ileus tubes. In Japan, the dedicated colorectal SEMS is not available and the esophageal stent with technical modifications is substituted. Covered or uncovered Esophageal SEMSs (Ultraflex; Boston Scientific) with 7 to 15 cm long and had a 17 to 23 mm central diameter were used. Results: In 22 lesions of 21 patients, SEMS insertions were performed as palliative to relieve obstruction. Prior to stent insertion, 10 lesions with total obstructions (45.5%) were decompressed with transanal ileus tubes. The sites of obstruction were ascending colon in 2 patients, descending colon in 2, sigmoid colon in 7, rectum in 10. With respect to the types of stents, the covered type of stents was employed in 13 lesions and the uncovered type in 9. Technical success in SEMS placements was achieved in 22 (100%) strictures. But one patient with a sigmoidvesical fistula subsequently underwent colostomy for an uncontrollable infection at the fistula after one week. All but this patient obtained clinical success in 21 (95.5%) lesions and the median stent patency was 121 days with a range of 26 to 511 days. There were no serious complications related to stent placement. In 4 lesions (19.0%), stents spontaneously evacuated from anus 98 to 148 days after insertion. After migration, Additional insertion of stent was required in two patients, tumor resection was performed in one patient, and colostomy was performed in one patient. There was no reobstruction of tumor ingrowth. Conclusions: By means of the covered stent and decompressions with the transanal ireus tube, SEMS may provide safe and effective palliation of patients with malignant obstructions in rectum to distal ascending colon.