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Colonic Self-Expandable Metal Stents: Indications and Placement Techniques

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Self-Expandable Stents in the Gastrointestinal Tract

Abstract

Self-expandable metal stents (SEMS) in the large bowel can be employed in malignant colorectal obstruction (MCRO), benign colorectal obstruction (BCRO), and rectocolonic fistulae (RCF). MCRO is the most frequent scenario. Endoscopic insertion of SEMS for colonic obstructions relies on crossing the stricture with a guidewire inserted through the working channel of an endoscope. Afterward, the undeployed SEMS is slid over the guidewire inside the working channel (through-the-scope or TTS insertion) or outside the scope (over-the-wire or OTW). The stent is finally opened up, bridging the entire stricture. Both endoscopic and fluoroscopic monitoring during the procedure are the best methods to achieve success. Insertion of colonic SEMS takes part in advanced therapeutic endoscopy, and special interventional skills are needed for the endoscopic team. For MCRO, an average of 93% in technical success and at least about 80% in clinical success has been reported. Patients can then either undergo scheduled surgery or have the stent left in place as a definitive palliative treatment. A complication rate up to 24 % can occur. Many are manageable endoscopically, but perforation (up to 9%) and death have been reported. Despite these drawbacks, initial treatment of MCRO by means of SEMS compares favorably with surgery. SEMS allow an earlier patients’ recovery, shorter hospital stay, lower rate of early complications, less need for colostomy, and chemotherapy to be administered earlier; have no detrimental effect on morbidity and survival; and have long-term efficacy comparable to that with surgery.

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Authors and Affiliations

  1. Department of Digestive Diseases, Hospital Virgen de La Luz, C/Hermandad Donantes de sangre n. 1, Cuenca, 16002, Spain

    Jesús García-Cano M.D., Ph.D.

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  1. Jesús García-Cano M.D., Ph.D.
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Correspondence to Jesús García-Cano M.D., Ph.D. .

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Editors and Affiliations

  1. , Virginia Mason Medical Center, Digestive Disease Institute, 1100 Ninth Ave, Seattle, 98111, Washington, USA

    Richard Kozarek

  2. , Division of Gastroenterology and Hepatol, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, 55905, Minnesota, USA

    Todd Baron

  3. , Department of Radiology, Asan Medical Center, Pungnap-2Dong 388-1, Seoul, 138-736, Korea, Republic of (South Korea)

    Ho-Young Song

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García-Cano, J. (2013). Colonic Self-Expandable Metal Stents: Indications and Placement Techniques. In: Kozarek, R., Baron, T., Song, HY. (eds) Self-Expandable Stents in the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3746-8_12

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  • DOI: https://doi.org/10.1007/978-1-4614-3746-8_12

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