Complications of Colorectal Stenting: Influence of the Type of Inserted Stent

Complications of Colorectal Stenting: Influence of the Type of Inserted Stent Javier Jimenez-Perez, Victor Orive, Gregorio Urdapilleta, Fernando Mugica, Fernando Borda Introduction: Colonic self-expandable stent placement is an accepted treatment of occlusive colorectal cancer, either to palliate the condition or to prepare the patient for an elective surgical resection. Major complications related to stent placement include bleeding, perforation, migration and stent obstruction. Minor complications include pain, incontinence/tenesmus and self limited bleeding. The aim of this study is to evaluate prospectively the incidence of complications related to colorectal stenting, seeking for possible differences depending on the type of stent. Methods: 92 patients (65 males;27 females. Age 40-91 yr) were referred for colonic stenting due to colorectal neoplastic obstruction. The tumor was located in the rectum or sigmoid colon in 86.8% of cases. Stent placement was succesful in 84 patients (91.3%). A nitinol stent was placed in 42 patients and a stainless steel stent in 42 patients. Stents were inserted through the working channel of a therapeutic colonoscope in every case. Minor compliations (pain, incontinence/tenesmus, self limited bleeding), major complications (severe bleeding, perforation, migration, reobstruction) and mortality were registered. Complications incidence in relation with the type of stent was also evaluated. Chi square test was used for statistical analysis. Results: Minor complications included pain (32.1%), incontinence/tenesmus (18.4%) and bleeding (9.2%). Concerning major complications, severe bleeding occured in 4.6% of cases, perforation in 2.3%, stent migration in 4.6% and stent reobstruction in 6.9% of patients. Mortality rate was 2.3% (2/84 patients). Comparing nitinol stents with stainless steel stents, pain (6/42 vs 21/42), severe bleeding (0/42 vs 4/42) and stent migration (0/42 vs 4/42) were more frequent with stainless steel stents, reaching statistical significance only for pain (p ! 0.0005). No differences were found when comparing the rest of registered complications. Conclusions: 1. The incidence of major complications related to colorectal stenting is low, although there is mortality related to the procedure. 2. Minor complications are rather frequent inmediately after stenting, but with little long term influence on patients quality of life. 3. The incidence of complications tends to increase using stainless steel stents, probably due to the stiffness and higher expansile force of the stent.