Palliation of malignant colorectal strictures with expandable metallic stents: Experience with 20 patients

Introduction: The application of expandable stents, commonly used for biliary and esophageal strictures is gaining acceptance in the treatment of colorectal strictures. We have previously reported our data of 13 patients with colorectal strictures palliated with expandable stents, and now update our experience with 20 patients. Methods: There were 12 men and 8 women with the average of 54 years (range 38-72). The primary diagnosis was colorectal cancer in 16, cervical/ ovarian cancer in 3 and transitional cell cancer in 1 patient. The site of obstruction was the rectum in 9, sigmoid in 10 and transverse colon in 1 patient. All patients had obstructive symptoms. Previous treatment included laser ablation in 5 and surgery in 3 patients. All patients had a prior Barium enema examination to define the length and course of the stricture. The tumor was exophytic in 10 and infiltrative in 6 patients. Extrinsic compression was seen in 4 patients. The endoscope could be advanced beyond the stricture in 8/20 patients. In the other 12 patients a standard biliary cannula was advanced through and contrast injected to define the length and course of the stricture. Dilation was needed in 9 patients (balloon 4, bougies 5). Guidewires were advanced through the strictures as far proximal as possible. Results: Stent placement was successful in 18/20 (90%) patients. All of these 18 (90%) patients had significant clinical improvement. Stents could not be placed in two patients with cervical/ovarian cancers because of the torturosity of the strictures. Dedicated enteral Wallstents (Schneider) were placed in 14, non-enteral Wallstents in 5 (esophageal 4, biliary 1) and Ultraflex (Microvasive) in 1 patient. The mean follow-up was 8 months (range 1-14). There were two complications (10%); one patient developed a recto-vesical fistula, which was successfully treated with a coated esophageal Wallstent-I. Tumor ingrowth was seen at the time of endoscopy. The second patient, who had received a biliary Wallstent, had distal migration of the stent. The average survival was 5.2 months (range 1-14). There were no procedure related morbidity or mortality. Conclusions: We conclude that expandable metallic stents are safe, effective and provide a reasonable palliative option for unresectable malignant colorectal strictures.