Technical and Clinical Outcomes After Colorectal Stenting in Malignant Large Bowel Obstruction: A Single Centre Experience

Atanu Pal; Janak Saada; Sandeep Kapur; Richard Tighe; Adam Stearns; James Hernon; Chris Speakman; Atanu Pal

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저자정보: Atanu Pal (Norfolk and Norwich University Hospital Cambridge University Hospitals) Janak Saada (Norfolk and Norwich University Hospital) Sandeep Kapur (Norfolk and Norwich University Hospital) Richard Tighe (Norfolk and Norwich University Hospital) Adam Stearns (Norfolk and Norwich University Hospital) James Hernon (Norfolk and Norwich University Hospital) Chris Speakman (Norfolk and Norwich University Hospital) Atanu Pal (Norfolk and Norwich University Hospital Cambridge University Hospitals)

저널정보: 대한대장항문학회 Annals of Coloproctology Annals of Coloproctolgy Vol.37 No.2

발행연도: 2021.1

수록면: 85 - 89 (5page)

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Purpose: Malignant large bowel obstruction is a surgical emergency that requires urgent decompression. Stents are increasingly being used, though reported outcomes are variable. We describe our multidisciplinary experience in using stents to manage malignant large bowel obstruction. Methods: All patients undergoing colorectal stent insertion for acute large bowel obstruction in a teaching hospital were included. Outcomes, complications, and length of stay (LOS) were recorded. Results: Over a 7-year period, 73 procedures were performed on 67 patients (37 male, mean age 76 years). Interventional radiology was involved in all cases. Endoscopic guidance was required in 24 cases (33%). In 18 patients (27%), treatment intent was to bridge to elective surgery; 16 had successful stent placement; all had subsequent curative resection (laparoscopic resection 8/18, primary anastomosis 14/18). Overall LOS, including both index admission and elective admission, was 16.4 days. Treatment intent was palliative in 49 patients (73%). In this group, stents were successfully placed in 41/49 (84%). Complication rate within 30 days was 20%, including perforation (2 patients), per rectal bleeding (2), stent migration (1), and stent passage (5). Nineteen patients (39%) required subsequent stoma formation (6 during same admission, 13 during subsequent admission). Overall LOS was 16.9 days. Conclusion: In our experience colorectal stents can be used effectively to manage malignant large bowel obstruction, with only selective endoscopic input. As a bridge to surgery, most patients can avoid emergency surgery and have a primary anastomosis. In the palliative setting, the complication rate is acceptable and two-thirds avoid a permanent stoma.

#Colorectal stent # Large bowel obstruction # Stoma

참고문헌 (18)

참고문헌 신청

Mohd Suan MA / 2015 / Intestinal obstruction: predictor of poor prognosis in colorectal carcinoma? / Epidemiol Health 37:e2015017

van den Berg MW / 2014 / Bridge-to-surgery stent placement versus emergency surgery for acute malignant colonic obstruction / Br J Surg 101:867~873

Tomita M / 2019 / Self-expandable metallic stenting as a bridge to surgery for malignant colorectal obstruction: pooled analysis of 426 patients from two prospective multicenter series / Surg Endosc 33:499~509

Fernandez-Esparrach G / 2010 / Severe complications limit long-term clinical success of self-expanding metal stents in patients with obstructive colorectal cancer / Am J Gastroenterol 105:1087~1093

Cirocchi R / 2013 / Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: a systematic review and meta-analysis / Surg Oncol 22:14~21

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