Secondary colonic stent insertion in acute large bowel obstruction following primary stent failure

Abstract

Introduction Colonic stent insertion has been shown to be an effective treatment for patients with acute large bowel obstruction, either as a bridge to surgery or as definitive treatment. However, little is known of the role of secondary stent insertion following primary stent failure in patients considered inappropriate or high risk for emergency surgery. Methods Fourteen patients presenting with acute large bowel obstruction who had previously been treated with colonic stent insertion were studied. All underwent attempted placement of a secondary stent. Results Technical deployment of the stent was accomplished in 12 patients (86%) but only 9 (64%) achieved clinical decompression. Successful deployment and clinical decompression of a secondary stent was associated with older age (p=0.038). Sex, pathology, site of obstruction, duration of efficacy of initial stent and cause of primary failure were unrelated to outcome. No procedure related morbidity or mortality was noted following repeated intervention. Conclusions Secondary colonic stent insertion appears an effective, safe treatment in the majority of patients presenting with acute large bowel obstruction following failure of a primary stent.

“Stent in Stent” Procedure for Treatment of Extreme Strictures of Colorectal Cancer – Case Series in a Single Center: How to Do it

“…Oistamo et al in a retrospective single-center cohort study, includes all patients submitted to colon surgery and he compared 23 patients submitted to proximal stoma (stoma group) and 20 patients treated to surgery after self-expanding metal stent positioning, and he demonstrated a higher number for removed lymph nodes in the stent group than in the stoma group (8.7 vs 21; p=0.001) [7]. As suggest by Lazzaro, Saini, Elton et al secondary colonic stent positioning is feasible in acute large bowel obstruction when primary positioning fails [8].…”