Colon Cancer 7
How accepted are the stents right now? Well things really changed in 1993. This was the first randomized controlled trial comparing the plastic rigid-type stents to the … this was actually the Wallstent that was used, a randomized trial and following this the stents really gained a lot of acceptance and began to be used much more frequently. This study, as you will recall, isn’t a perfect study in that patients were kept in the hospital for a long time for the plastic stents, for dilation and general anesthesia and such, but the important take-home message is that the expandable metal stents were just as effective technically and functionally, but the complication was much less significant for the expandable metal stents. Perforations, pneumonias, migrations, didn’t occur in this limited study. And that’s really held true over the last six or seven years. Self-expanding stents require minimal pre-stent dilation. As I mentioned, the smaller caliber stents can be placed typically without any dilation whatsoever. The technical success across the board, looking at different series, between 90-100% – and most importantly – the functional success. The patient actually gets relief of dysphagia again at a very significant rate.
What are the complications? Well they are slowly going down as operators gain more experience, but most significantly perforations now are occurring at a less than 1% rate. Serious complications including major bleeding, sepsis, perforation, across the board are somewhere in that 2.5-3% range all together. One caveat to keep in mind, your patients who have already received radiation therapy, bleeding, perforations, other complications occur much more frequently in this sub-population of patients.