The role of self-expandable metallic stents as “bridge to surgery” for the treatment of acute malignant colorectal obstruction. Our experience

Abstract

INTRODUCTION: Despite the widespread use of screening programs, the colorectal cancer occurs in 7-29% of cases with a bowel obstruction, needing an immediate decompression treatment by emergency surgery; unfortunately, the emergency surgery is characterized by high morbidity and mortality rates. The endoscopic placement of self-expandable metallic stents can be a useful alternative, allowing to decompress the acute obstruction in a short time, in order to correct dehydration, electrolytic imbalance and to improve the overall clinical conditions prior to adequately plan the intervention of elective surgery.

AIM: The objective of our study was to evaluate the clinical success and potential complications related to the stent placement as “bridge to surgery”.

MATERIALS AND METHODS: Twenty-four patients with acute intestinal obstruction due to colorectal cancer were retrospectively observed in our Surgery Unit. They were selected only patients in whom technical success, defined as the correct placement of the stent, was recorded. All patients underwent a preoperative abdominal X-rays and whole body contrast-enhanced Computed Tomography (ceCT). Furthermore, an intraoperative fluoroscopy was also performed to obtain a better anatomical depiction of the lesions. The sites of obstruction were in the left colon (n=13) and in the proximal rectal tract (n=11). Covered and uncovered stents were placed respectively in 12 and 12 patients. The Over The Wire (OTW) technique has been used in 11 patients while the Through The Scope (TTS) technique in 13 subjects. All patients were brought to elective surgery in 5-10 days. The clinical success was defined as the resumption of normal bowel function within 48-72 hours and the absence of complications.

RESULTS: Technical success was documented in 24 patients (100%). Clinical success was recorded in 17 patients (70.8%) while, in 7 patients, as treatment complications were recorded: 2 stent migrations (8.3%), 2 cases with tenesmus (8.3%), 2 bleeding (8.3%), 2 cases of abdominal pain (8.3%) and 1 case of perforation (4.2%), were recorded.

CONCLUSION: In our series we found that placing self-expandable metallic stents, considered as “bridge to surgery”, was a useful technique in the resolution of acute malignant colorectal obstructions, with high success rate and low rate of complications.