Low Morbidity and Mortality after Stenting for Malignant Bowel Obstruction

Abstract

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.

Endoscopic stenting of acutely obstructing colorectal cancer: a 10‐year review from a tertiary referral centre

“…The World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) combined consensus document states that stenting of obstructing distal colonic cancer is the best therapeutic option in centres where the skills to perform the procedure are present, which would support such a service being offered in a centre such as our Trust. The number of cases that are currently being managed at our Trust per annum is relatively small, but this mirrors previous case series’ in the literature, and would further support centralization of such a service. This is contradictory to the view of Krishnan et al .…”

“…Insertion of SEMS for acutely obstructing distal CRCs is a cost‐effective and safe therapeutic option with a relatively low complication rate, and a lower 30‐day mortality rate than that of emergency resection, which is widely quoted in the literature at 15–30% . Stenting increases the chance of avoiding a potentially permanent stoma in the acute situation, offers acceptable palliation and allows a proportion of patients to undergo planned surgery at a later date, often without a permanent stoma .…”

Radiological Position and Clinical Outcome of Preoperative Self-Expanding Metal Stents for Obstructing Colonic Cancer: A Single-Centre Cohort Study

“…The department of gastroenterology and gastrointestinal surgery at the Deventer Hospital has a long-standing protocol of preoperative stent placement as first-line treatment for obstructing colorectal tumor and thus has built up a relatively large series, with published satisfactory results [26] . This is confirmed by the current analysis, showing a technical success rate of 92% and a clinical success rate of 85%.…”

Colonic Stent as Bridge to Surgery in Patients with Obstructive Left-Sided Colon Cancer

“…Finally, the criteria used to determine the timing of surgery in this series are somewhat subjective, as was mentioned before for previous studies. 22 – 25 …”