Colorectal stenting for malignant and benign disease: Outcomes in colorectal stenting

INTRODUCTION: Self-expanding metal stents are now an established treatment for malignant colonic obstruction. Favorable outcomes have been reported both for cancer palliation and treatment of acute obstruction as a "bridge" to surgery. However, little data exists regarding the use of stents for benign colonic obstruction. METHODS: All cases of colonic stent insertion occurring between December 1996 to October 2002 were reviewed. During the study period, 36 patients with malignant obstruction and 6 patients with benign obstructive disease underwent placement of self-expandable stents using a combined endoscopic and fluoroscopic technique. RESULTS: Stent placement was successful in 36 of 42 patients (86 percent). Complications occurred in 16 of 36 patients (44 percent): migration (n = 7), reobstruction (n = 5), perforation (n = 2), fistula formation (n = 1), and stent fracture (n = 1). Stent placement was successful in 100 percent of patients with benign strictures but poststent migration was frequent (2/6). CONCLUSIONS: Stent insertion provided an effective outcome in patients with malignant colonic obstruction as a palliative and preoperative therapy. Although a relatively high migration rate was observed in patients with benign strictures, stenting was still effective in providing luminal patency (median follow-up, 7.5 months). Stenting should be considered as a first-line treatment for malignant strictures and as a potential therapy for selected benign strictures.