Stenting for Malignant Colorectal Obstruction
Acute colorectal obstruction is a clinically significant complication that can be caused by malignant condition including colorectal cancer and other intra-abdominal malignancies, and it is sometimes life-threatening to patients. There are two options to manage this clinically hazardous condition, emergency surgery and stenting. Self-expandable metallic stent (SEMS) has been popular since it was first reported in 1991 for palliation of malignant colonic obstruction. As we know, surgical resection of the obstructive lesion or stoma formation is still the mainstay in the treatment, but emergency operation has higher risk of morbidity and mortality than elective one. Also, if a patient has inappropriate conditions for surgery, SEMS would be the good alternative method to figure out the dangerous situation. The major indications of SEMS for colonic stenting are preoperative decompression and palliation of malignant colonic obstruction. Although SEMS placement is safe and effective and has advantages over surgery, there have been controversies about its short-term and long-term clinical outcomes. In this chapter, we are going to look into general information, indications, prerequisites, techniques, post-procedural care, and complication of colorectal stenting for malignant obstruction.