[Metal endoprosthesis in the treatment of acute neoplastic occlusion of the colon. Our experience]

BACKGROUND

Acute large-bowel obstruction represents a surgical challenge whose management is controversial, usually requiring emergent surgery in adverse circumstances with increased morbidity and mortality compared with elective situations.

METHODS

We report our experience with self-expanding metal stents in the initial management of acute neoplastic colorectal obstruction. From December 2000 to February 2003, insertion of self-expanding metal stents under endoscopic and fluoroscopic guidance was attempted in 22 patients, in 9 as primary palliative measure (group A) whereas in 13 as a bridge to surgery (group B).

RESULTS

Stenting was technically successful in 20 patients. There were 2 perforations, and one patient died as a consequence. Nine of the 11 patients in the group B underwent elective colonic resection while in two patients with advanced malignancy the stent was considered as a definitive palliative treatment. In all 10 patients with ultimate prosthesis (8 group A, 2 group B) two dislocations and one recurrent obstruction were noted in the mean follow-up of 12 months.

CONCLUSION

Self expanding metal stents represent a good option in the treatment of large bowel obstruction, providing time for a complete preoperative evaluation and mechanical bowel preparation as well as for restoring patient's general conditions thus avoiding emergency surgery with considerably lower morbidity and mortality rates. In patients with advanced cancer, they provide an alternative to surgery with satisfactory results.

[172 consecutive total gastrectomies for gastric cancer with Roux-en-Y loop reconstruction and without fistulization of the esophago-jejunal anastomosis]

In the treatment of gastric cancer total gastrectomy (TG) is one of the most important operation and the esophagojejunal anastomotic leakage is the most important early complication. In our series of 172 consecutive TGs (all controlled with Gastrografin-Rx in fifth postoperative day) we did not have any anastomotic fistula, independently from age, stage, type of limphadenectomy and visceral demolition. We believe that the correct technical performance is the most important factor in the esophagojejunal anastomosis.