Colorectal stenting as an effective therapy for preoperative and palliative treatment of large bowel obstruction: 9 years’ experience

Alcántara, Manuel Jesús; Serra, X.; Bombardó, J.; Falcó, Joan; Perandreu, Joan; Ayguavives, I.; Mora, Laura; Hernando, Raphael; Navarro, Salvador

doi:10.1007/s10151-007-0372-8

Cited by 40 publications

(24 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our elective surgery morbidity and mortality rates are consistent with previously published data with results ranging between 0 and 22 % and between 0 and 5 % , respectively ( 5,8,16,30,32 ). Our morbidity results included both surgical complications and all medical adverse events during the postsurgery hospital stay, thus making our rate higher than that in reports by others who only considered anastomotic dehiscence ( 32 ). A similar comment can be made about our mortality rate, as two of the three patients who died aft er surgery had fatal medical complications (cerebral insult and aspiration pneumonia) and only one died because of a surgery-related complication (abdominal abscess and further sepsis).…”

Section: Discussionsupporting

confidence: 91%

“…Th e authors suggested that factors contributing to the high perforation incidence might have been stent design and chemotherapy ( 31 ) and the selection of a patient population with an increased risk of complications, or that perhaps the short interval (5 -16 days) between stent placement and elective surgery did not allow for optimal bowel decompression and improvement in the clinical condition of the patient ( 25 ). Our elective surgery morbidity and mortality rates are consistent with previously published data with results ranging between 0 and 22 % and between 0 and 5 % , respectively ( 5,8,16,30,32 ). Our morbidity results included both surgical complications and all medical adverse events during the postsurgery hospital stay, thus making our rate higher than that in reports by others who only considered anastomotic dehiscence ( 32 ).…”

Section: Discussionsupporting

confidence: 86%

See 1 more Smart Citation

Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

Jiménez-Perez

Casellas

García-Cano

et al. 2011

American Journal of Gastroenterology

View full text Add to dashboard Cite

OBJECTIVES:To date, this is the largest prospective series in patients with malignant colorectal obstruction to evaluate the effectiveness and safety of colonic self-expanding metal stents (SEMSs) as an alternative to emergency surgery. SEMSs allow restoration of bowel transit and careful tumor staging in preparation for elective surgery, hence avoiding the high morbidity and mortality associated with emergency surgery and stoma creation. METHODS:This report is on the SEMS bridge-to-surgery subset enrolled in two multicenter international registries. Patients were treated per standard of practice, with documentation of clinical and procedural success, safety, and surgical outcomes. RESULTS:A total of 182 patients were enrolled with obstructive tumor in the left colon (85 % ), rectum (11 % ), or splenic fl exure (4 % ). Of these patients, 86 % had localized colorectal cancer without metastasis. Procedural success was 98 % (177 / 181). Clinical success was 94 % (141 / 150). Elective surgery was performed in 150 patients (9 stomas) and emergency surgery in 7 patients for treatment of a complication (3 stomas). The overall complication rate was 7.8 % (13 / 167), including perforation in 3 % (5 / 167), stent migration in 1.2 % (2 / 167), bleeding in 0.6 % (1 / 167), persistent colonic obstruction in 1.8 % (3 / 167), and stent occlusion due to fecal impaction in 1.2 % (2 / 167). One patient died from complications related to surgical management of a perforation.CONCLUSIONS: SEMSs provide an effective bridge to surgery treatment with an acceptable complication rate in patients with acute malignant colonic obstruction, restoring luminal patency and allowing elective surgery with primary anastomosis in most patients.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 86%

Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

Jiménez-Perez

Casellas

García-Cano

et al. 2011

American Journal of Gastroenterology

View full text Add to dashboard Cite

show abstract

“…In patients suitable for curative surgery, stenting allows time for preoperative bowel preparation, rehydration and institution of nutritional therapy (17). In the bridge to surgery group with malignant lesions, 60% of the patients in the present study had elective surgery.T his correlates well to Meisner et al (21) and Alcantara et al (24) (Table 2) who reported 44.7% and 95%, respectively.…”

Section: Discussionsupporting

confidence: 88%

A Clinical Evaluation of Endoscopicallyplaced Self-Expanding Metallic Stents in Patients with Acute Large Bowel Obstruction

et al. 2009

View full text Add to dashboard Cite

Background and Aims: self-expanding metallic stents (sems) have since 1991 established themselves as an option in the treatment of large bowel obstruction. the aim of this study was to evaluate the use of sems in management of acute colorectal obstructions at a danish surgical gastroenterology center. Material and Methods: retrospective review of charts from all patients who, in the period marts 2002 to december 2007 underwent insertion of as ems for an acute large bowel obstruction.Results: of 45 patients included, sems was intended as a bridge to surgery in 20 patients and as palliation in 25 patients. for malignant etiology,the sems procedure was at echnical and clinical success in 97.4% of the cases. complications occurred in 21%, mortality rate 2,6%. for benign etiology,the sems procedure was atechnical success in 85.7%, and a clinical success in 71.4%. complications occurred in 71.4% of the benign cases with amortality rate of 28,6%.Conclusions: placement of sems for acute large bowel obstruction with malignant etiology is an effective and safe procedure with low mortality and morbidity. however results for benign obstructions are questionable and more research is needed to determine the role of sems.

show abstract

“…Both the introduction procedure as well as the stent itself may induce colonic perforation, the latter either by radial pressure on the tumor or by bowel wall erosion at the edges of the SEMS. Several case series have reported that SEMS-related perforations occur in up to 5% of cases [4,5]. Furthermore, it has been suggested that the cannulation of the obstructive malignancy and placement of a SEMS may enhance dissemination of tumor cells and thus promote the development of metastatic disease.…”

Section: Introductionmentioning

confidence: 99%

Low Morbidity and Mortality after Stenting for Malignant Bowel Obstruction

Driest

Zwaving²,

Ledeboer³

et al. 2011

Dig Surg

View full text Add to dashboard Cite

Background: The difference in mortality between emergency and elective surgery for malignant colonic obstruction is more than 5% in healthy patients below the age of 65 and increases with age to around 20%. Emergency surgery can be avoided by endoscopic placement of a self-expandable metal stent (SEMS). Aim: To evaluate the effectiveness and safety of SEMS as ‘bridge to surgery’. Method: Between January 2001 and July 2008, SEMS were placed for acute malignant colonic obstruction in 45 patients (median age 72 years, range 35–91). Results: The procedure was technically successful in 43 patients (94%) with resolution of obstructive symptoms within 48 h in 87% of the patients. No perforations occurred during the procedure or while awaiting surgery. Two (4%) patients required a second endoscopic procedure. All patients underwent a single-stage surgical procedure. Postoperative mortality was 2.2% (n = 1). Histology showed advanced colorectal cancer (T3–4N1–2M0–1) in 75% of the patients. Conclusion: SEMS placement is a safe and effective procedure as bridge to surgery in patients presenting with colonic obstruction due to colorectal malignancy. This procedure carries a risk of serious complications well below that of the reported difference in mortality between emergency an elective surgery.

show abstract

Colorectal stenting as an effective therapy for preoperative and palliative treatment of large bowel obstruction: 9 years’ experience

Abstract: Self-extending stents resolve colorectal cancer obstruction and allow optimal patient staging and scheduled surgical treatment. Stenting is also a useful option in advanced or irresectable tumors, avoiding the need for surgery and offering good palliation.

Cited by 40 publications

References 30 publications

Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

A Clinical Evaluation of Endoscopicallyplaced Self-Expanding Metallic Stents in Patients with Acute Large Bowel Obstruction

Low Morbidity and Mortality after Stenting for Malignant Bowel Obstruction

Contact Info

Product

Resources

About