Introduction A significant number of colon cancer patients present with obstruction which is a surgical emergency. Emergency decompression surgery is associated with 25% mortality.1 Self expandable metal stent (SEMS) provides a low-risk and successful option for managing them.2 This study evaluates the outcome of the use of SEMS in malignant colonic obstruction (MCO) in a district general hospital (DGH).
Methods This retrospective study includes patients with MCO treated with SEMS over a period of 4 years. All the stentings were done by an experienced gastroenterologist. The Endoscopy reporting software (Unisoft), stent logbook, histology database and patient admitting system (PAS) were reviewed for data collection. Information regarding indication, site of the lesion, stent, procedure outcome, adverse events, discharge time and patient demographics were reviewed.
Results 52 patients had SEMS for MCO in the study period. 40 (76.9%) had elective and 12 (23.1%) had emergency stenting. The age range is from 48 to 93 years with a mean of 75.4 years. Majority of the patients were male (34, 65.4%). All patients with emergency stenting were admitted with total large bowel obstruction and 2 (16.6%) of them had post-stent curative surgery where as 6 (15%) of the elective group also had post-stent curative surgery. So in eight patients (15.4%) SEMS was used as bridge for surgery and in 44 (84.6%) it had a palliative role. Boston Scientific colonic stents (WallFlex) were used for all patients. The sites of the lesions were sigmoid 32 (61.5%), rectum 10 (19.3%), descending colon 7 (13.4%) and transverse colon 3 (5.8%). Extravasation of contrast occurred in 2 (3%), migration in 3 (5.8%) resulting in stent removal and blockage in 1 (1.9%) followed by Hartmann's procedure, giving a complication rate of 10.7%. The technical success rate is 100% (no procedural failure) and the clinical success rate is 89.3% (functional stent without complication). Average duration of post stenting hospital stay was 3.92 days.
Conclusion The key of our successful colonic stenting service (technical success—100%, clinical success—89.3% and successful bridging of 15.4% (n=8) to curative surgery) is the result of careful patient selection and delivery of the service by a single experienced operator. There was no procedure related mortality compared to emergency surgery of 25%. We feel all DGH with acute surgical intake should be equipped to provide this safe and useful service.
Competing interests None declared.
References 1. Tekkis PP, Kinsman R, Thompson MR, et al. The Association of Colo-proctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg 2004;240:76–81.
2. Aaron J, Coelho-Prabhu N, Baron TH, et al. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc 2010;71:560–72.