Inserción endoscópica de prótesis metálicas autoexpandibles en obstrucciones tumorales del colon / Endoscopic insertion of self-expanding metal stents in malignant colonic obstructions

Antecedentes y objetivo: Las prótesis metálicas autoexpandibles se están utilizando, cada vez con más frecuencia, para resolver la obstrucción colónica tumoral. Después, los pacientes pueden intervenirse de forma electiva o bien, en casos no aptos para la cirugía, la prótesis sirve como tratamiento paliativo definitivo. Presentamos la experiencia de esta técnica en un hospital de nivel II del Sistema Nacional de Salud. Pacientes y métodos: Estudio retrospectivo de un período de 42 meses (desde mayo de 2002 hasta octubre de 2005), durante el cual se trató de resolver la obstrucción colónica en 43 ocasiones a 40 pacientes, mediante la inserción endoscópica de prótesis. Resultados: La inserción fue técnicamente posible en 41 intentos (95%) y se obtuvo un buen resultado clínico en 37 ocasiones (86%). Se utilizó sólo endoscopia 23 veces (53,5%), y en las otras 20 (46,5%) también fluoroscopia. De los 38 pacientes en que se obtuvo un buen resultado con la inserción, 34 lograron un éxito clínico total. Se intervino de forma electiva a 24 (63%) pacientes y la prótesis se consideró un tratamiento paliativo definitivo en 14 (37%). Hubo que intervenir finalmente a uno de estos pacientes por una fístula colovesical. Además de esta complicación, hubo otras 8: 3 prótesis migraron, una se obstruyó, 2 pacientes tuvieron tenesmo, otro presentó una bacteriemia tras la inserción, y se descubrió una perforación silente por la prótesis en una cirugía electiva. No hubo mortalidad derivada de las complica ciones. Conclusiones: En nuestra experiencia, la inserción endoscópica de prótesis parece un método seguro y eficaz en el tratamiento inicial de la obstrucción colónica tumoral

Background and objective: Self-expanding metal stents are being increasingly used to resolve malignant colonic obstruction. Subsequently, patients can either undergo elective surgery, or the stent can serve as a definitive palliative treatment in patients unfit for surgery. We present our experience with this technique in our hospital, a level II center within the Spanish National Health Service, which can be considered a community hospital. Patients and methods: A retrospective study was performed of a 42-month period (May 2002 to October 2005), during which malignant colonic obstruction was treated by means of endoscopically inserted stents on 43 occasions in 40 patients. Results: Stent insertion was successfully performed in 41 attempts (95%) and good clinical results were obtained on 37 occasions (86%). Endoscopic means alone were used on 23 occasions (53.5%) and in the remaining 20 (46.5%), both endoscopy and fluoroscopy were employed. Of 38 patients with successfully inserted stents, clinical success was achieved, as a whole, in 34. Twenty-four of these patients (63%) subsequently underwent elective surgery while the stent served as a definitive palliative treatment in the remaining 14 (37%). One of these patients had to undergo further surgery due to a fistula between the colon and the bladder. There were eight other complications: three stent migrations and one stent obstruction occurred, two patients had tenesmus, one patient developed bacteremia after stent insertion, and a silent bowel perforation by the stent was found in an elective surgical procedure. There was no mortality. Conclusions: In our experience, endoscopically inserted stents seem to be a safe and effective method for the initial treatment of malignant colonic obstruction

[Endoscopic insertion of self-expanding metal stents in malignant colonic obstructions]. / Inserción endoscópica de prótesis metálicas autoexpandibles en obstrucciones tumorales del colon.

BACKGROUND AND OBJECTIVE: Self-expanding metal stents are being increasingly used to resolve malignant colonic obstruction. Subsequently, patients can either undergo elective surgery, or the stent can serve as a definitive palliative treatment in patients unfit for surgery. We present our experience with this technique in our hospital, a level II center within the Spanish National Health Service, which can be considered a community hospital. PATIENTS AND METHODS: A retrospective study was performed of a 42-month period (May 2002 to October 2005), during which malignant colonic obstruction was treated by means of endoscopically inserted stents on 43 occasions in 40 patients. RESULTS: Stent insertion was successfully performed in 41 attempts (95%) and good clinical results were obtained on 37 occasions (86%). Endoscopic means alone were used on 23 occasions (53.5%) and in the remaining 20 (46.5%), both endoscopy and fluoroscopy were employed. Of 38 patients with successfully inserted stents, clinical success was achieved, as a whole, in 34. Twenty-four of these patients (63%) subsequently underwent elective surgery while the stent served as a definitive palliative treatment in the remaining 14 (37%). One of these patients had to undergo further surgery due to a fistula between the colon and the bladder. There were eight other complications: three stent migrations and one stent obstruction occurred, two patients had tenesmus, one patient developed bacteremia after stent insertion, and a silent bowel perforation by the stent was found in an elective surgical procedure. There was no mortality. CONCLUSIONS: In our experience, endoscopically inserted stents seem to be a safe and effective method for the initial treatment of malignant colonic obstruction.