[Treatment of colorectal obstruction with self-expanding metal stents]

Self-expanding metal stents (SEMS) serve as a bridge to surgery in cases of acute colorectal obstruction and provide palliation without surgery in patients with severe co-morbidity or disseminated disease. We describe our experiences with the use of SEMS in colorectal obstruction.

We analysed a consecutive series of 162 SEMS procedures in 141 patients (72 men (51%)) in the period between May 1997 and September 2004. The median age of the patients was 75 years (range 28-101). In 11 patients the stricture was caused by benign pathology. The indication of the procedure was in 62 (44%) of the cases in patients with cancer acute obstruction.

Seventeen patients needed more than one SEMS procedure. Perforation of the colon by the stent was seen in 2% of the cases, and the frequency of stent migration was 10%. The 30-day mortality rate after SEMS procedure and subsequent resection was 17% in cases of malign acute obstruction. Resection without stoma was achieved in 76% of the cases. Fifteen patients with acute obstruction received SEMS as the definitive treatment. In the group of patients who received SEMS as palliation, only 10% needed a stoma in the follow-up period. In 11 cases of benign strictures, only 4 were successful.

SEMS is a safe, effective procedure in the treatment of colorectal obstruction. It reduces the mortality and morbidity rates, as well as the need for stomas. In our experience, stenting of benign strictures is ineffective and associated with higher rates of complications.