The results of the use of endoscopic colorectal stenting with metal stents as palliative care

The aim of the study. To develop the optimal surgical technique of the endoscopic colorectal stenting. To analyze the results of the endoscopic colorectal stenting in patients with stenosis unresectable colon tumors.

Material and methods. In the period from 2016 to 2022, we studied the results of the endoscopic colorectal stenting of various parts of the the colon with metal stents in 86 patients with stenosing unresectable colon tumors.

Results. In 14 patients (16,3 %) with difficult-to-reach localization of stenosing tumor and complex anatomy of the colon, we applied the transparent plastic cap at the distal end of the colonoscope. There were no intraoperative complications. Technical and clinical success was achieved in 98,8 % of cases. The pain syndrome persisted in 19 patients (22,1 %) during the period of hospitalization; the chronic pain syndrome was recorded in 3 (3,5 %) patients in the postoperative period. 3 months after surgery, colorectal stent-to-stent restenting was performed in 13 patients (15,1 %) with the repeated tumor obstruction. No cases of the stent migration were recorded 3 months after surgery.

Conclusion. Endoscopic colorectal stenting is a highly effective and safe intervention that allows to achieve for rapid relief of clinical symptoms of intestinal obstruction and demonstrates a low incidence of postoperative complications. In presence of the complex intestinal anatomy, as well as a difficult-to-reach localization of a stenosing tumor, we consider it advisable to use a distal transparent plastic cap, which is justified by more adequate visual positioning of the intestinal lumen, which allows better endoscopic intestinal stenting.

1. Kaprin A.D. Sostoianie onkologicheskoi pomoshchi naseleniiu Rossii v 2012 godu. Pod redaktciei A.D. Kaprina, V.V. Starinskogo, G.V. Petrovoi. M.: FGBU «MNIOI im. P.A. Gertcena» Minzdrava Rossii, 2013, № 232 p. (In Russ.).

2. Aliev S.A., Aliev E.S., Zeinalov B.M. Stentirovanie tolstoi kishki v khirurgicheskom lechenii kolorektalnogo raka, oslozhnennogo kishechnoi neprokhodimostiu. Vestnik khirurgii imeni I.I. Grekova, 2016, № 175(4), pp. 108-112. (in Russ.).

3. Repici A, Adler DG, Gibbs CM et al. Stenting of the proximal colon in patients with malignant large bowel obstruction: techniques and outcomes. Gastrointest. Endosc., 2007, 66, pp. 940–944. https://doi.org/10.1016/j.gie.2007.04.032

4. Dohmoto M. New method: endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endoscopia Digestiva., 1991, № 3, pp. 1507–1512.

5. Totikov Z.V., Totikov V.Z., Epkhiev A.A. Strength properties of bowel wall and safety of endoscopic stenting in patients with colorectal cancer and acute obstruction. Koloproktologiia, 2019, № 18, 3(69). pp. 71–76. (In Russ.) https://doi:10.33878/2073-7556-2019-18-3-71-76

6. Shabunin A.V., Bagateliia Z.A., Persov M.Iu., Anikina S.S. Recanalization of colon in the treatment of patients with acute malignant obstructive colonic obstruction. Khirurgiia. Zhurnal im. N.I. Pirogova, 2023, 6, pp. 86–95. (In Russ.) https://doi.10.17116/hirurgia202306186

7. Morino M, Arezzo A, Farnesi F, Forcignanò E. Colonic Stenting in the Emergency Setting. Medicina (Kaunas), 2021, 1, 57(4), pp. 328. https://doi:10.3390/medicina57040328

8. Bokarev M.I., Mamykin A.I., Muntianu E.V. The effectiveness of endoscopic colon stenting in patients with acute malignant colonic obstruction. Vestnik Natcionalnogo mediko-khirurgicheskogo tcentra im. N.I. Pirogova, 2021, № 16, 1, pp. 52–56. (In Russ.) https://doi:10.25881/BPNMSC.2021.47.56.009

9. Tculeiskiri B.T., Iartcev P.A., Blagovestnov D.A. Colon stenting in obturation colon obstruction. Vestnik novykh meditcinskikh tekhnologii, 2022, № 16, 4, pp. 33–41. (In Russ.) https://doi:10.24412/2075-4094-2022-4-1-5

10. Sebastian S, Johnston S, Geoghegan T et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstructionю Am. J. Gastroenterol., 2004, 99, pp. 2051–2057. https://doi:10.1111/j.1572-0241.2004.40017.x

11. Mabardy A., Miller P., Goldstein R., Coury J., Hackford A., Dao H. Stenting for obstructing colon cancer: fewer complications and colostomies. JSLS, 2015, № 9(1), pp. e2014.00254. https://doi:10.4293/JSLS.2014.00254

12. Lim T-Z, Tan K-K. Endoscopic stenting in colorectal cancer. J Gastrointest Oncol., 2019, № 10(6), pp. 1171–1182. https://doi:10.21037/jgo.2019.02.15

13. Van Halsema E.E., van Hooft J.E., Small A.J., Baron T.H., GarcíaCano J., Cheon J.H., Lee M.S., Kwon S.H., Mucci-Hennekinne S., Fockens P, Dijkgraaf MG, Repici A. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc., 2014, № 79(6), pp. 970– 982. https://doi:10.1016/j.gie.2013.11.038

14. Small A.J., Coelho-Prabhu N., Baron T.H. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: longterm outcomes and complication factors. Gastrointest Endosc., 2010, № 71(3), pp. 560–572. https://doi:10.1016/j.gie.2009.10.012

15. Fung B.M., Chen F.C., Tabibian J.H. Clear cap-assisted luminal stenting may improve technical success in gastroduodenal and colonic obstruction. Endoscopy international open, 2020, № 8(10), pp. 1429–1434. https://doi:10.1055/a-1229-4000