Stenting of the proximal colon in patients with malignant large bowel obstruction: techniques and outcomes

BACKGROUND: Self-expandable metal stents are used throughout the GI tract to relieve malignant obstructions. OBJECTIVE: Our purpose was to determine the outcome after colonic stent placement into the proximal colon. DESIGN: Medical records of patients from 3 institutions who underwent attempts at placement of self-expandable metal stents for malignant obstructions of the proximal colon were retrospectively reviewed. Extracted data included patient characteristics, obstruction location, and goal of procedure (palliation vs bridge to surgery). SETTING: Academic medial centers. PATIENTS: Those with right-sided malignant colonic obstruction. INTERVENTIONS: Placement of colonic stent. MAIN OUTCOME MEASUREMENTS: Initial technical success, relief of obstruction, and early and long-term complications. RESULTS: Twenty-one patients (15 men, 6 women; mean age 67 years) were included. Tumor type was colonic adenocarcinoma in 19 patients. Obstruction was complete in 8 patients and subtotal in 13 patients. Stenting was attempted as a bridge to surgery in 8 patients and as palliation in 13 patients. Initial technical success was achieved in 20 of 21 patients (95%). Complete relief of obstruction was achieved in 17 of 20 patients who had technical success (85%), unachieved in 2 patients (No. 14 and 17), and unknown in 1 patient (No. 6). There were no procedure-related complications (bleeding, perforation, etc). The only long-term complication was stent reocclusion from tumor ingrowth. LIMITATIONS: Retrospective, single-arm analysis. CONCLUSIONS: Self-expandable metal stents appear to be safe and effective in the treatment of malignant obstruction of the proximal colon. Technical and clinical success rates are comparable to those seen with distal colonic stenting.