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Abstract
Introduction The aim of this study is to assess our outcomes of colonic stenting for colorectal malignancies in a DGH where we provide stenting without the support of interventional radiologist. NICE guidelines recommend facilities and services should be established to provide stenting for patients with intestinal obstruction, particularly those with serious co-morbidity to avoid emergency surgery1. We run a colorectal laparoscopic unit adequately according to NICE recommendations although we do not have support of interventional radiologist
Methods It is retrospective study of all stents which were inserted in a DGH by a surgeon between 2004 and 2012. All patients had presented with acute bowel obstruction caused by malignant colorectal diseases and structuring. Data was collected prospectively by the colorectal specialist nurse on a pre-designed database format.
In the stent insertion no support of interventional radiologist was available. However all stents were inserted by a surgeon with the help of endoscopes and fluoroscopy in X-ray department.
Results Out of 54 patients 51 had successful stenting initially. However on three occasions stenting was not successful. Out of 51 who had successful stenting in three of them stents were not found adequately relieving obstruction so they ended up having stoma. The complete success rate in 48 patients was 88%. The indications of stenting were for relief of acute bowel obstruction, palliation and as a bridge to surgery. Complications were noted in
Seven cases (14.58) including one perforations and one migration, one obstructive symptoms persisted and four had growth of the tumour at the lower end of the stents where restenting was not successful.. There were no incidents of acute or delayed haemorrhage in any patients.
Conclusion This study demonstrated that stenting for obstructing colorectal cancers is a safe and effective method of relieving acute and impending bowel obstruction. It is also a preferred method of converting an acute surgery into an elective surgery by “bridging to surgery” in order to optimise patient’s condition before surgery.
Our study also showed that stenting can be provided safely and effectively in a district general hospital by a trained surgeon without the help of interventional radiologist.
Disclosure of Interest None Declared.