Elsevier

Gastrointestinal Endoscopy

Volume 53, Issue 2, February 2001, Pages 203-206
Gastrointestinal Endoscopy

Original Articles
Use of self-expanding metal stents for palliation of rectosigmoid cancer

https://doi.org/10.1067/mge.2001.112196Get rights and content

Abstract

Background: Patients with large bowel obstruction can be palliated by colostomy or by endoscopic modalities that restore luminal patency. The clinical results of a series of patients with rectosigmoid cancer in whom self-expanding metal stents were inserted at endoscopy are presented. Methods: Thirty-seven patients with symptoms related to obstructive rectosigmoid adenocarcinoma were treated by endoscopic insertion of self-expanding metal stents. Results: Metal stents were correctly placed in 36 of 37 patients (97%) with no immediate complications. Early dislodgment of the stent (within 1 week) was observed in 3 cases. The remaining 33 patients (92%) were followed for a median of 7 months (3 weeks-33 months). In 28 patients (78%) there was long-term restoration of luminal patency and disappearance of obstructive symptoms without further treatments. They experienced no pain, tenesmus, or incontinence during the follow-up period. The incidence of complications (early and late) and the mortality rate related to the procedure were 22% and 3%, respectively. Conclusions: Endoscopic metal stents can be considered a simple and effective solution for long-term palliation of rectosigmoid cancer. (Gastrointest Endosc 2001;53:203-6.)

Section snippets

Patients and methods

From November 1990 to February 1999, 37 patients (mean age, 76 years; range 39-95; 19 men) with stenosing rectal or rectosigmoid cancer were treated by endoscopic insertion of self-expanding metal stents in a prospective series. Inclusion criteria were the presence of primary or recurrent malignant rectal or rectosigmoid stenosis in patients deemed unfit for surgery because of local extension, metastatic disease, or high surgical risk. Exclusion criteria were the presence of rectal stenosis

Results

Metal stents were placed correctly in 36 of the 37 patients (97%). In the first patient to undergo the procedure, the metal stent was placed partially proximal to the lesion. During endoscopic removal of the stent with a polypectomy snare, metallic mesh was damaged. Two patients had stenoses that were 9 cm long and required placement of 2 stents in series.

All patients tolerated the procedure well and no complication was observed within 24 hours of stent placement. The only early complications

Discussion

Although surgery provides excellent palliation for patients with obstructing rectosigmoid cancer, the surgical mortality rate is as high as 17% and there is no evidence that palliative resections prolong survival.16 Furthermore, the presence of a colostomy decreases the quality of life.17 Hence many patients refuse colostomy and request alternative noninvasive treatments that maintain bowel continuity and continence.

The reported success of various palliative endoscopic and other nonsurgical

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    Reprint requests: Pasquale Spinelli, MD, Divisione di Diagnostica e Chirurgia Endoscopica, Istituto Nazionale Tumori, Via Venezian 1, 20133 Milano, Italy.

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