Low Morbidity and Mortality after Stenting for Malignant Bowel ObstructionDriest J.J. · Zwaving H.H. · Ledeboer M. · Eeftinck Schattenkerk M. · Kuipers E.J. · ter Borg F.
Departments of aGastroenterology and Hepatology and bGastrointestinal Surgery, Deventer Hospital, Deventer, and cDepartment of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
Background: The difference in mortality between emergency and elective surgery for malignant colonic obstruction is more than 5% in healthy patients below the age of 65 and increases with age to around 20%. Emergency surgery can be avoided by endoscopic placement of a self-expandable metal stent (SEMS). Aim: To evaluate the effectiveness and safety of SEMS as ‘bridge to surgery’. Method: Between January 2001 and July 2008, SEMS were placed for acute malignant colonic obstruction in 45 patients (median age 72 years, range 35–91). Results: The procedure was technically successful in 43 patients (94%) with resolution of obstructive symptoms within 48 h in 87% of the patients. No perforations occurred during the procedure or while awaiting surgery. Two (4%) patients required a second endoscopic procedure. All patients underwent a single-stage surgical procedure. Postoperative mortality was 2.2% (n = 1). Histology showed advanced colorectal cancer (T3–4N1–2M0–1) in 75% of the patients. Conclusion: SEMS placement is a safe and effective procedure as bridge to surgery in patients presenting with colonic obstruction due to colorectal malignancy. This procedure carries a risk of serious complications well below that of the reported difference in mortality between emergency an elective surgery.
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