Endoscopic Self-Expanding Metals Stents for Large Bowel Obstruction – Experience in a District General Hospital
AuthorsMcBrearty A, Johnston D, McKenna C, Caddy G, Tham T, McElvanna K
Departments / InstitutionsDepartment of General Surgery and Gastroenterology, Ulster Hospital Dundonald
Publication DateAutumn 2017
In colorectal cancer (CRC), 20% of patients present as an emergency. Controversy exists on the safety of colonic stenting as an alternative to surgery for potentially curable obstructing left-sided disease.
The purpose of this study was to review the use of self-expanding metallic stents (SEMS) in CRC presenting with acute large bowel obstruction.
A retrospective review was performed of SEMS insertion between January 2011 and December 2016 as an extension to a previous study. Patients were identified from theatre records, endoscopy database and patients’ notes. Data including demographics, morbidity, mortality, disease-free survival, perforation rate and stoma rate were recorded.
78 patients were included. 26 were stented as a bridge-to-surgery (BTS) and 52 for palliation. Technical success was achieved 76.9%(20/26) of BTS group. 90d morbidity 23.1%(6/26). Permanent stoma rate 34.6%(9/26). 90d clinical perforation rate 7.7%(2/26) (overall 5 in those patients under 70years, 3 in patients over 70years). 88.5%(23/26) proceeded to surgery. Median survival was 595days (range 1-2339; disease-free survival 161 – 2038days). 90d mortality 11.5%. Successful decompression was achieved in 78.7%(41/52) of palliative patients.
The role of SEMS in tumour microperforation remains unclear. Furthermore, upstaging of disease is likely to contribute to worse outcome. One third of BTS patients under 70years in our study had evidence of perforation on histological assessment. We propose that BTS SEMS insertion is not appropriate in patients aged less than 70years who are fit for surgery. In palliative patients, SEMS insertion remains a good option for symptom control.