Intestinal stenting is a procedure that is rapidly coming into more widespread use. It is reported to be a safe and highly effective alternative in patients with unresectable intestinal obstruction. Recent reports show the value of this procedure in colorectal obstruction, as it is relatively safe and can avoid the need for high-risk emergency laparotomy and resection in two sessions. New stents can be inserted in a one-step procedure, with delivery through the scope during the initial diagnostic endoscopy. If examinations show that curative treatment is not possible, resection can be completely avoided, so that the initial stent already forms part of the palliative strategy. Although stents are expensive, the procedure appears to be cost-effective, since emergency surgery can be avoided in patients with acute bowel obstruction, and in those with advanced disease no resection of the colon is necessary.
References
-
1
Deans G T, Krukowski Z H, Irwin S T.
Malignant obstruction of the left colon.
Br J Surg.
1994;
81
1270-1276
-
2
Barillari P, Aurello P, de Angelis R. et al .
Management and survival of patients affected with obstructive colorectal cancer.
Int Surg.
1992;
77
251-255
-
3
Neuhaus H, Hangenmüller F, Classen M.
Self-expanding biliary stents: preliminary clinical experience.
Endoscopy.
1989;
21
225-228
-
4
Knyrim K, Wagner H J, Bethge N. et al .
A controlled trial of an expandable metal stent for palliation of esophageal obstruction due to inoperable cancer.
N Engl J Med.
1993;
329
1302-1307
-
5
Keymling M, Wagner H J, Vakil N, Knyrim K.
Relief of malignant duodenal obstruction by percutaneous insertion of a metal stent.
Gastrointest Endosc.
1993;
39
439-441
-
6
Dohmoto M.
New method: endoscopic implantation of rectal stent in palliative treatment of malignant stenosis.
Endosc Dig.
1991;
3
1507-1512
-
7
Davidson R, Sweeney W B.
Endoluminal stenting for benign colonic obstruction.
Surg Endosc.
1998;
12
353-354
-
8
Pikarsky A J, Efron J E, Weiss E G. et al .
Overcoming Wallstent malposition in the treatment of rectosigmoid obstruction.
Surg Endosc.
2000;
14
372
-
9
Raijman I, Siemens M, Marcon N.
Use of an expandable Ultraflex stent in the treatment of malignant rectal stricture.
Endoscopy.
1995;
27
273-276
-
10
Campbell K L, Hussey J K, Eremin O.
Expandable metal stent application in obstructing carcinoma of the proximal colon: report of a case.
Dis Colon Rectum.
1997;
40
1391-1393
-
11
Tominaga K, Yoshida M, Maetani I, Sakai Y.
Expandable metal stent placement in the treatment of a malignant anastomotic stricture in the transverse colon.
Gastrointest Endosc.
2001;
53
524-527
-
12
Baron T H, Dean P A, Yates M R. et al .
Expandable metal stents for the treatment of colonic obstruction: technical outcomes.
Gastrointest Endosc.
1998;
47
277-285
-
13
Camunez F, Echenagusia A, Simo G. et al .
Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation.
Radiology.
2000;
216
492-497
-
14
de Gregorio M A, Mainar A, Tejero E. et al .
Acute colorectal obstruction: stent placement for palliative treatment - results of a multicenter study.
Radiology.
1998;
209
117-120
-
15
Mainar A, de Gregorio Ariza M A, Tejero E. et al .
Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery - results of a multicenter study.
Radiology.
1999;
210
65-69
-
16
Choo I W, Do Y S, Suh S W. et al .
Malignant colorectal obstruction: treatment with a flexible covered stent.
Radiology.
1998;
206
415-421
-
17
Law W L, Chu K W, Ho J WC. et al .
Self-expanding metallic stent in the treatment of colonic obstruction caused by advanced malignancies.
Dis Colon Rectum.
2000;
43
1522-1527
-
18
Lopez C M, Martinez J MR, Cebrian E T. et al .
Treatment of left colon neoplastic obstruction by placement of self-expandable stents.
Rev Esp Enferm Dig.
2001;
93
232-237
-
19
Knöpfle E, Mayer H, Wamser G. et al .
Ileus beim colorectalen Carcinom. Präoperative Implantation eines Metallgitterstents und frühelektive Operation als Alternative zur notfallmässigen Operation.
Chirurg.
2001;
72
1137-1143
-
20
Diaz L P, Pabon I P, Lobato R F, Lopez C M.
Palliative treatment of malignant colorectal strictures with metallic stents.
Cardiovasc Intervent Radiol.
1999;
22
29-36
-
21
Wallis F, Campbell K L, Eremin O, Hussey J K.
Self-expanding metal stents in the management of colorectal carcinoma: a preliminary report.
Clin Radiol.
1998;
53
251-254
-
22
Turegano-Fuentes F, Echenagusia-Belda A, Simo-Muerza G. et al .
Transanal self-expanding metal stents as an alternative to palliative colostomy in selected patients with malignant obstruction of the left colon.
Br J Surg.
1998;
85
232-235
-
23
Lamah M, Mathur P, McKeown B. et al .
The use of rectosigmoid stents in the management of acute large bowel obstruction.
J R Coll Surg Edinb.
1998;
43
318-321
-
24
Dohmoto M, Hünerbein M, Schlag M.
Application of rectal stents for palliation of obstructing rectosigmoid cancer.
Surg Endosc.
1997;
11
758-761
-
25
Spinelli P, Dal Fante M, Mancini A.
Rectal metal stents for palliation of colorectal malignant stenosis.
Bildgebung.
1993;
60
48-50
-
26
Tack J, Gevers A M, Rutgeerts P.
Self-expandable metallic stents in the palliation of rectosigmoidal carcinoma: a follow-up study.
Gastrointest Endosc.
1998;
48
267-271
-
27
Mainar A, Tejero E, Maynar M. et al .
Colorectal obstruction: treatment with metallic stents.
Radiology.
1996;
198
761-764
-
28
Saida Y, Sumiyama Y, Nagao J, Takase M.
Stent endoprosthesis for obstructing colorectal cancers.
Dis Colon Rectum.
1996;
39
552-555
-
29
Canon C L, Baron T H, Morgan D E. et al .
Treatment of colonic obstruction with expandable metal stents: radiologic features.
Am J Roentgenol.
1997;
168
199-205
-
30
Arnell T, Stamos M J, Takahashi P. et al .
Colonic stents in colorectal obstruction.
Am Surg.
1998;
64
986-988
-
31
Binkert C A, Ledermann H, Jost R. et al .
Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents - a preliminary report.
Radiology.
1998;
206
199-204
-
32
Soonawalla Z, Thakur K, Boorman P. et al .
Use of self-expanding metallic stents in the management of obstruction of the sigmoid colon.
Am J Roentgenol.
1998;
171
633-636
-
33
Boorman P, Soonawalla Z, Sathanathan N. et al .
Endoluminal stenting of obstructed colorectal tumors.
Ann R Coll Surg Engl.
1999;
81
251-254
-
34
Adamsen S, Holm J, Meisner S. et al .
Endoscopic placement of self-expanding metal stents for treatment of colorectal obstruction with long term follow-up.
Dan Med Bull.
2000;
47
225-227
-
35
Repici A, Reggio D, DeAngelis C. et al .
Covered metal stents for management of inoperable malignant colorectal strictures.
Gastrointest Endosc.
2000;
52
735-740
-
36 Reister A. Dissertation. Giessen; JLU 2002: in preparation
-
37
Lopera J E, Ferral H, Wholey M. et al .
Treatments of colonic obstructions with metallic stents: indications, technique, and complications.
Am J Roentgenol.
1997;
169
1285-1290
M. Keymling, M.D.
Medizinische Klinik II · Klinikum Meiningen GmbH
Bergstrasse 3 · 98617 Meiningen · Germany
Fax: + 49-3693-901234
Email: med2.keymling@klinikum-meiningen.de
