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    Stent in CRC Obstruction

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    ANDRE MA
    This document discusses endoscopic stent placement for malignant colonic obstruction. It outlines the indications, including palliation for surgically incurable colorectal cancer (CRC) and bridging to surgery to avoid emergent procedures. Contraindications include systemic toxicity, intra-abdominal abscess, coagulopathy, and distal rectal lesions. Self-expanding metal stents are commonly used and can be uncovered or covered. Complications of stent placement include perforation in 4% of cases, bleeding, abdominal pain, stent migration in 12% of cases, and stent occlusion. Failure of colonic decompression can also occur.

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    Stent in CRC Obstruction

    Uploaded by

    ANDRE MA
    17 views2 pages
    This document discusses endoscopic stent placement for malignant colonic obstruction. It outlines the indications, including palliation for surgically incurable colorectal cancer (CRC) and bridging to surgery to avoid emergent procedures. Contraindications include systemic toxicity, intra-abdominal abscess, coagulopathy, and distal rectal lesions. Self-expanding metal stents are commonly used and can be uncovered or covered. Complications of stent placement include perforation in 4% of cases, bleeding, abdominal pain, stent migration in 12% of cases, and stent occlusion. Failure of colonic decompression can also occur.

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    Stent in CRC Obstruction

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    This document discusses endoscopic stent placement for malignant colonic obstruction. It outlines the indications, including palliation for surgically incurable colorectal cancer (CRC) and bridging to surgery to avoid emergent procedures. Contraindications include systemic toxicity, intra-abdominal abscess, coagulopathy, and distal rectal lesions. Self-expanding metal stents are commonly used and can be uncovered or covered. Complications of stent placement include perforation in 4% of cases, bleeding, abdominal pain, stent migration in 12% of cases, and stent occlusion. Failure of colonic decompression can also occur.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    17 views2 pages

    Stent in CRC Obstruction

    Uploaded by

    ANDRE MA
    This document discusses endoscopic stent placement for malignant colonic obstruction. It outlines the indications, including palliation for surgically incurable colorectal cancer (CRC) and bridging to surgery to avoid emergent procedures. Contraindications include systemic toxicity, intra-abdominal abscess, coagulopathy, and distal rectal lesions. Self-expanding metal stents are commonly used and can be uncovered or covered. Complications of stent placement include perforation in 4% of cases, bleeding, abdominal pain, stent migration in 12% of cases, and stent occlusion. Failure of colonic decompression can also occur.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    Enteral

    stents in malignant colonic obstruction



    Indication for endoscopic stent placement
    - Palliation (surgically incurable CRC)
    - Bridge to surgery (avoid emergent two-step procedure + allow optimization of pt)
    - Mx for pts with extracolonic pelvic tumours (e.g. ovarian ca)

    Contraindications
    - Systemic toxicity (à do emergency surgery)
    - Intra-abdominal abscess
    - Persistent coagulopathy
    - Distal rectal lesions (avoid due to tenesmus)
    Bevacizumab
    - High perforation rates
    - à Stent should be avoided in pts who are/will be receiving anti-angiogenic agents

    Types of stents
    - Self-expanding metal stent (SEMS)
    o Uncovered (meshwork is bare wire)
    o Covered (meshwork covered à decrease tissue growth into the stent)
    § Mainly in malignant colo-vesical, colo-enteric, colo-vaginal fistulas
    § Less ingrowth, more migration
    Preprocedure
    - Bowel prep
    o Partial obstruction (distal) à cleansing water enemas
    o Partial obstruction (proximal) à oral bowel prep
    - Antibiotics (NOT needed for most, unless complete obstruction)

    Placement
    - Endoscopic guidance + fluoroscopy
    - Colonoscopy à insufflation (CO2)















    Cx of Colonic stent placement

    (Self-expanding metal stents, SEMS) – 25% cx rate
    -Respiratory compromise (respiratory depression, with hypoxia, hypercarbia)
    Sedation related -Cardiovascular instability
    -Vomiting & aspiration
    Procedure related
    - Perforation (4%)
    o Immediate or delayed
    o More in distal colon (sharp angulation & redundancy)
    o Cx: peritoneal seeding in CRC
    - Bleeding
    o Immediate
    § Tumour friability
    § Superficial tearing of stented tissue
    § Mucosal irritation
    o Delayed
    § Ulcerations / erosions
    - Abdominal pain
    o Transient (up to 5 days) à give analgesics
    Stent related
    - Stent migration (12%)
    o Stent too narrow/small/short
    o Colonic stricture is non obstructive
    o Tumour shrinks post chemo/RT
    - Stent occlusion
    o Tumour ingrowth through or overgrowth at either end of the stent
    o May require additional stent within the original stent
    - Recurrent obstruction (7%)
    - Failure of colonic decompression
    o Additional sites of intestinal obstruction (e.g. synchronous lesions)
    o Fecal impaction within a newly inserted stent
    o Incomplete stenting of the entire length
    o Early stent migration
    o Poor stent positioning
    o Incomplete stent expansion
    o Underlying motility disorder
    Assess
    o Retrograde contrast study (water soluble enema)

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