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document
Management of large bowel obstruction with self-expanding metal stents . A multicentre retrospective study of factors determining outcome . AIM UK cancer guidelines recommend patients with colonic obstruction due to suspected malignancy be considered for stenting with a self-expanding metal stent ( SEMS ) . Considerable variation in practice exists due to a lack of expertise , technical difficulties and other , as yet ill-defined features . This retrospective multi-centre study aims to determine the outcome following colonic stenting for large bowel obstruction and identify factors associated with successful intervention . METHOD A regional programme of colonic stenting for large bowel obstruction , in five UK centres from 2005 to 2010 was evaluated for outcome including technical and clinical success , survival , complications and reoperation . RESULTS A SEMS was inserted in 334 patients , including 264 ( 79.0 % ) for palliation and 52 ( 15.6 % ) as a bridge to surgery . Technical success was achieved in 292 ( 87.4 % ) patients , with 46 ( 13.8 % ) experiencing a complication or technical failure . Reoperation was required in 39 ( 14.8 % ) patients stented for palliation of colorectal cancer of whom 16 ( 6.1 % ) subsequently required a colostomy . A one-stage primary anastomosis was achieved in 35 ( 67.3 % ) of the 52 patients undergoing stenting as a bridge to resection . Technical success did not vary by indication or site of obstruction ( P = 0.60 ) but was higher for operators who had performed more than 10 procedures ( OR 3.34 , P = 0.001 ) . ASA grade ≥3 predicted a worse clinical outcome ( OR 0.43 , P = 0.04 ) . The through-the-scope ( TTS ) endoscopy technique was more successful than radiological placement alone ( 90.3 % vs 74.8 % , P < 0.001 ) . CONCLUSION Experienced operators using a TTS technique achieved a better outcome for the emergency management of large bowel obstruction . Older , sicker patients and those with extracolonic and benign strictures fared less well .
63793
Intervention_Surgical
self-expanding metal stents
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Intervention_Surgical
stenting with a self-expanding metal stent ( SEMS )
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Intervention_Surgical
SEMS
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Outcome_Other
technical and clinical success
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Outcome_Mortality
survival
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Outcome_Adverse-effects
complications
63799
Outcome_Other
Technical success
63800
Outcome_Other
Reoperation
63801
Outcome_Other
one-stage primary anastomosis
63802
Outcome_Other
Technical success
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Outcome_Other
indication or site of obstruction
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Participant_Condition
colonic obstruction
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Participant_Condition
malignancy
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Participant_Sample-size
334 patients
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Participant_Sample-size
264
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Participant_Sample-size
52
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Participant_Condition
colorectal cancer
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Participant_Sample-size
52