Download PDF
Semin intervent Radiol 2004; 21(3): 205-216
DOI: 10.1055/s-2004-860941
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Colon Stenting: A Review

Miguel Angel de Gregorio1 , 2 , 3 , Antonio Mainar2 , Juan Rodriguez3 , Eduardo Ramon Alfonso2 , Eloy Tejero2 , Marcos Herrera2 , Jokin Medrano2 , Horacio D'Agostino3
  • 1Professor
  • 2Interventional Radiology, Universidad de Zaragoza, Zaragoza, Spain
  • 3Department of Radiology, Health Sciences Center, Lousiana State University, Shreveport, Louisiana
Further Information

Publication History

Publication Date:
16 December 2004 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Up to 85% of patients who present with colonic obstruction have a colorectal cancer. Between 7% and 29% of these patients present with total or partial intestinal obstruction. Only 20% of these patients presenting with acute colonic obstruction due to malignancy survive 5 years. Emergent surgical intervention in patients with colonic obstruction is associated with significant morbidity and mortality rates. Only 40% of patients with obstructive carcinoma of the left colon can be treated with surgical resection without the need for a colostomy. The use of a temporary or permanent colostomy has a significant impact on quality of life. The decompressive effect seen with colonic stenting is a durable, simple, and effective palliative treatment of patients with advanced disease. Stent deployment provides an effective solution to acute colonic obstruction and allows surgical treatment of the patient in an elective and more favorable condition. In addition, colonic stenting reduces costs and avoids the need for a colostomy.

KEYWORDS

Colon cancer - intestinal obstruction - colonic stenting

REFERENCES

  • 1 Boyle P, Leon M. Epidemiology of colorectal cancer.  Br Med Bull. 2002;  64 1-25
    PubMedGoogle Scholar
  • 2 Deans G T, Krukowski Z H, Irwin S T. Malignant obstruction of the left colon.  Br J Surg. 1994;  81 1270-1276
    CrossrefPubMedGoogle Scholar
  • 3 Duxbury M, Brodribb A, Oppong F, Hosie K. Management of colorectal cancer: variations in practice in one hospital.  Eur J Surg Oncol. 2003;  29 400-402
    CrossrefPubMedGoogle Scholar
  • 4 Griffith R. Prospective medical obstacles to surgery.  Cancer. 1992;  70 1333-1341
    PubMedGoogle Scholar
  • 5 Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T. Emergency surgery for colon carcinoma.  Dis Colon Rectum. 2003;  46 24-30
    CrossrefPubMedGoogle Scholar
  • 6 Ohman U. Prognosis in patients with obstructing colorectal carcinoma.  Am J Surg. 1982;  143 742-747
    CrossrefPubMedGoogle Scholar
  • 7 Witzig J A, Morel P, Erne M, Egeli R, Borst F, Rohner A. Chirugie des cancers digestifs des patients de plus de 80 ans.  Helv Chir Acta. 1993;  59 767-769
    PubMedGoogle Scholar
  • 8 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
    PubMedGoogle Scholar
  • 9 Neugent K, Daniels P, Stewart B, Patankar R, Johnson C D. Quality of life in stoma patients.  Dis Colon Rectum. 1999;  42 1569-1574
    CrossrefPubMedGoogle Scholar
  • 10 Dohmoto M, Rupp K D, Hohlbach G. Endoscopically-implanted prosthesis in rectal carcinoma.  Dtsch Med Wochenschr. 1990;  115 915
    PubMedGoogle Scholar
  • 11 Cwikiel W, Andren-Sandberg A. Malignant stricture with colovesical fistula: stent insertion in the colon.  Radiology. 1993;  186 563-564
    PubMedGoogle Scholar
  • 12 Keen R, Orsay C P. Rectosigmoid stent for obstructing colonic neoplasms.  Dis Colon Rectum. 1992;  35 912-913
    PubMedGoogle Scholar
  • 13 Tejero E, Mainar A, Fernandez L, Tobio R, de Gregorio M A. New procedure for the treatment of colorectal neoplastic obstructions.  Dis Colon Rectum. 1994;  37 1158-1159
    CrossrefPubMedGoogle Scholar
  • 14 Zollikofer C, Jost R, Schonh E, Decurtins M. Gastrointestinal stenting.  Eur Radiol. 2000;  10 1158-1159
    CrossrefPubMedGoogle Scholar
  • 15 Mauro M, Koehler R, Baron T. Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents.  Radiology. 2000;  215 659-669
    CrossrefPubMedGoogle Scholar
  • 16 de Gregorio M A, Mainar A, D'Agostino H, Herrera M, Tejero E, Medrano J. Trasanal metallic stents for malignant colonic obstructions in 126 patients.  J Vasc Interv Radiol. 1999;  10(suppl) 219
    PubMedGoogle Scholar
  • 17 Mainar A, de Gregorio 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
    PubMedGoogle Scholar
  • 18 Mischima R, Sawada S, Tanigawa N, Okuda Y, Kobayashi M, Koyama T. Expandable metallic stent treatment for malignant colorectal strictures.  Cardiovasc Interv Radiol. 1999;  22 155-158
    PubMedGoogle Scholar
  • 19 Akle C A. Endoprostheses for colonic strictures.  Br J Surg. 1998;  85 310-314
    CrossrefPubMedGoogle Scholar
  • 20 Song H Y. Malignant gastric outlet obstruction: treatment by means of coaxial placement of uncovered and covered expandable Nitinol stents.  J Vasc Interv Radiol. 2002;  13 275-283
    CrossrefPubMedGoogle Scholar
  • 21 Canon C L, Baron T H, Morgan D E, Dean P A, Koeler R E. Treatment of colonic obstruction with expandable metal stents: radiologic features.  AJR Am J Roentgenol. 1997;  168 199-205
    PubMedGoogle Scholar
  • 22 Lopera J E, Ferral H, Wholey M, Maynar M, Castaneda-Zuniga W R. Treatment of colonic obstructions with metallic stents: indications, technique and complications.  AJR Am J Roentgenol. 1997;  169 1285-1290
    PubMedGoogle Scholar
  • 23 Adamsen S, Holm J, Meisner S, Moller P, Naver L P, Wille-Jorgensen P A. Endoscopic treatment of colorectal obstruction with self-expandable metal endoprosthesis.  Ugeskr Laeger. 2000;  162 1560-1563
    PubMedGoogle Scholar
  • 24 Choo I, Do Y, Suh S et al.. Malignant colorectal obstruction: treatment with a flexible covered stent.  Radiology. 1998;  206 415-421
    PubMedGoogle Scholar
  • 25 de Gregorio M A, Mainar A, Tejero E, Alfonso E R, Gimeno M J, Herrera M. Use of an introducer sheath for colonic stent placement.  Eur Radiol. 2002;  12 2250-2252
    PubMedGoogle Scholar
  • 26 Velling T E, Hall L D, Brennan F J. Colonic stent placement facilitated by percutaneous cecostomy and antegrade enema.  AJR Am J Roentgenol. 2000;  175 119-120
    PubMedGoogle Scholar
  • 27 Gimeno M J, Alfonso E R, Herrera M, Tobio R, Medrano J, de Gregorio M A. Palliative treatment of malignant stenoses of transverse colon by autoexpandable metallic stent through percutaneous cecostomy or colostomy.  Cardiovasc Intervent Radiol. 2002;  25(suppl) 208
    CrossrefPubMedGoogle Scholar
  • 28 Binkert C A, Ledermann H, Jost R, Saurenmann P, Decurtins M, Zollikofer C. 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
    PubMedGoogle Scholar
  • 29 de Gregorio M A, D'Agostino H, Gimeno M J et al.. Trasanal colonic stent implantation under fluoroscopy alone and under fluoroscopy and endoscopy. A comparative study.  Interventionismo. 2003;  5 103-111
    PubMedGoogle Scholar
  • 30 Khot U, Lang A, Murali K, Parker M. Systematic review of the efficacy and safety of colorectal stents.  Br J Surg. 2002;  89 1096-1102
    CrossrefPubMedGoogle Scholar
  • 31 Beltran J M. Left obstructive colonic carcinoma. Comparative study of short and middle-term results after a new therapeutic procedure based in self-expanding metallic stents placement [doctoral thesis]. Zaragoza, Spain; Universidad de Zaragoza 2003
    Google Scholar
  • 32 Martinez C, Lobato R, Fradejas J M, Pinto I, Ortega P, Moreno M. Self-expandable stent before elective surgery vs emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates.  Dis Colon Rectum. 2002;  45 401-406
    CrossrefPubMedGoogle Scholar
  • 33 Harris G, Senagore A, Lavery I, Fazio V. The management of neoplastic colorectal obstruction with colonic endolumenal stenting devices.  Am J Surg. 2001;  181 499-506
    CrossrefPubMedGoogle Scholar
  • 34 Odurny A. Colonic anastomotic stenoses and Memotherm stent fracture: a report of three cases.  Cardiovasc Intervent Radiol. 2001;  24 336-339
    CrossrefPubMedGoogle Scholar
  • 35 Osman H, Rashid H, Sathananthan N, Parker M. The cost-effectiveness of self- expanding metal stents in the management of malignant left-sided bowel obstruction.  Colorectal Dis. 2000;  2 233-237
    CrossrefPubMedGoogle Scholar
  • 36 de Gregorio M A, Mainar A, Gimeno M J et al.. Radiation exposure during metallic stent placement for the treatment of malignant colonic obstruction: experience with 12 patients.  Cardiovasc Intervent Radiol. 2001;  24 S189
    PubMedGoogle Scholar
  • 37 Gimeno M J, Medrano J, Alfonso E R, de Gregorio M A. Utility of fluoroscopy combined with endoscopy in the treatment of malignant colorectal stenosis with metallic stents.  Cardiovasc Intervent Radiol. 2002;  25 S203
    PubMedGoogle Scholar
  • 38 Turegano F, Echenagusia A, Simo A 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
    CrossrefPubMedGoogle Scholar
  • 39 Baron T H. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract.  N Engl J Med. 2001;  344 1681-1687
    CrossrefPubMedGoogle Scholar
  • 40 Maynar M, Qian Z. Current status of the expandable metallic stent for the treatment of colorectal obstruction.  Cardiovasc Intervent Radiol. 2001;  21(suppl) 114-116
    PubMedGoogle Scholar

Prof. Miguel Angel de Gregorio Ariza

Department of Interventional Radiology, Hospital Clinico Universitario

San Juan Bosco 15

Zaragoza 50009, Spain

Email: mgregori@separ.es

      >