Introduction Colonic self-expanding metallic stent(C-SEMS) is used to relieve malignant bowel obstruction. Our study aims to assess and review the outcomes of C-SEMS in patients with colorectal cancer against current guidance(1-2).
Method Retrospective review was conducted of all C-SEMS inserted between 2010 - 2015 and procedure-related outcomes and adherence to national guidelines was assessed.
Results 85 C-SEMS were inserted in 83 patients (32 female)– 72 were palliative decompression and 11 as bridge to surgery. Mean age was 74.1 years. 78 had left-sided colonic lesions, 3 right-sided colonic lesions and 2 low rectal lesions. All patients had CT scan prior to C-SEMS, one had radiological evidence of perforation and was stented with good outcome. Evolution Cook uncovered stents was used in all cases. Success 1 st attempt was achieved in 93%(n=79), of the 6 remaining patients - 2 had successful repeat attempt, 2 died from perforation,one patient had cardiopulmonary arrest mid-procedure (this patient had a pre-existing DNACPR in place), one was deemed too unwell for endoscopy and managed supportively. Patients with low rectal lesions tolerated C-SEMS well without troublesome tenesmus. Immediate complications occurred in 9.4%(n=8) - perforation and death(n=2),stent migration(n=6). Late complications in 16.4%(n=14) re-obstruction due to tumour growth, of which 2 died from perforation. 7 out of 8 patients who subsequently underwent surgery had a de-functioning stoma.11 patients had C-SEMS as bridge to surgery - 10 had successful surgery and one died from complications of anastomotic leak. We had no bleeding complications, including those 21 patients who were on anti-platelet/anti-coagulants. 30 day mortality rate was 4.8% (n=4). Overall mortality was 36.4%, all were palliative intent C-SEMS.
Conclusion C-SEMS is a safe and effective alternative to surgery in malignant colorectal obsturction as demonstrated in our review. Although current national guidelines suggest otherwise, our study shows C-SEMS is an alternative in right-sided and low rectal lesions in expert hands. In acute bowel obstruction, patients on anti-platelet/anti-coagulant should proceed with C-SEMS, as the risk of haemorrhage following C-SEMS is reportedly low (2).
. National Institute for Health and Clinical Excellence Colorectal cancer Clinical guideline [CG131], 2014.
. SVM Murugesan, M Hendrickse.Colonic stenting in patients on P2Y12 receptor antagonists and direct oral anticoagulants:are current BSG/ESGE guidelines practical?Gut2016. doi:10.1136/gutjnl-2016-311781.
Disclosure of Interest None Declared
- COLORECTAL CANCER