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"We're now seeing more individuals presenting with advanced stage colorectal cancer, with up to 29 percent of patients having acute colonic obstruction," explains David Schaffzin, MD, Virtua colorectal surgeon. "Colonic stenting, when appropriate, is a highly effective bridge to surgery or long-term palliation."
Eytan Irwin, MD, chief of colon and rectal surgery at Virtua West Jersey Hospitals, describes the situation: "Traditionally, we performed a temporary colostomy for large bowel obstructions. But some studies have shown significant post-operative morbidity and mortality with this approach. Stenting provides an interim solution that reduces the need for a temporary colostomy and effectively decompresses the colon. This allows for pre-operative colon preparation or chemo-radiation for tumor down-staging." Dr. Schaffzin adds: "Most importantly, when a stent is used as a bridge to surgery with potentially curable disease, survival is not adversely influenced."
Indications for colonic stenting include obstructions from neoplasms or extracolonic cancer, such as ovarian or uterine cancer, as well as for diverticulitis and Crohn's disease. The self-expandable stent is placed under endoscopic and fluoroscopic guidance. Dr. Irwin: "For patients who come to surgery, the stent is removed, or it can remain in the colon to help restore function for patients with unresectable disease."
"With colonic stents, patients endure one less surgical procedure and that results in reducing morbidity," concludes Dr. Schaffzin.
This Virtua Physician article was last updated: August 21, 2008