McNamara, I.; Tremelling, M.; Dunkley, I.; Roberts, P.; Dickenson, R.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA74
Academic Journal
Background: The deployment of self expanding enteral stents via endoscopic and fluoroscopic guidance has emerged as effective treatment of large bowel obstruction in both the acute and elective setting. Methods: 20 consecutive patients (10 male), with a median age of 72 years were studied between 1997 and 2002 on an intention to treat basis. All patients had symptomatic large bowel strictures. Results: 26 procedures were performed on 20 patients. A total of 15 stents were inserted with successful placement on the first attempt in 13 procedures. One patient was stented on the second occasion and one patient was stented on the fourth occasion. In 5 patients (6 procedures) a wire could not be passed due to complete occlusion of the lumen or due to the position of the carcinoma which prevented viewing 'en face". The remainder of the failures were due to poor preparation of the colon, or the stenosis being too lax to be amenable to stenting. The cause of the stenosis was malignant in 19 cases with the sites being rectosigmoid (45%), sigmoid colon (40%), splenic flexure (10%), transverse colon (5%). Symptoms improved in all patients successfully stented but in one patient there was distal migration of the stent 3 days later. In the others good palliation was obtained with a median symptom free survival of 7 months. 14 patients died in follow up due to causes unrelated to stent insertion. Conclusion: Colonic stents have an important place in the management of large bowel obstruction and palliation of colonic carcinoma and should be available in any district general hospital.


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