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Combined use of covered and uncovered self-expandable metal stents in patients with bleeding, obstructing stage IV colorectal cancer.

Endoscopic placement of self-expandable metal stents (SEMS) represents a valid therapeutic method in selected patients with colorectal obstruction [1–5]. Here we report on a series of three patients with bleeding, obstructing stage IV colorectal cancer (CRC), who were initially treated with a covered stent, which was later replaced with an uncovered one. Uncovered stents rarely dislodge [5], reducing the possibility of acute colorectal obstruction after patient discharge. Three patients (mean age 72 years; two men, one woman) were admitted to the hospital with major rectal bleeding. At endoscopy, a CRC was identified, with ulcerated, bleeding mucosa. The cancer was located in the sigmoid colon in two patients and in the upper rectum in one patient.Ineachcase,thelumenwasalmost completely obstructed by the tumor. A computed tomography scan was performed and showed diffuse liver metastasisthat wasconsideredtobe unresectable. Multiple bleeding sites were controlled using argon laser but with difficulty. At the end of the procedure there was still some bleeding from the tumor. A covered SEMS (TaeWoong TTS full covered colonic stent; 10cm in length, 28mm in diameter; TaeWoongMedical Co., Ltd., Gimpo-si, Gyeonggi-do, South Korea)wasplaced underendoscopicandfluoroscopiccontrolin