Randomized controlled trial of colonic stent insertion in non-curable large bowel obstruction: apost hoccost analysis

Abstract Introduction The National Institute of Clinical Excellence (NICE) updated guidance in January 2020 and recommend colonic stent insertion for acute left-sided bowel obstruction as either palliative treatment or a bridge to elective surgery. Colonic stent insertion has shown improved outcomes in reducing hospital stay and stoma rate when compared to emergency surgery in patients presenting with large bowel obstruction. Objectives This service evaluation aimed to identify indications, complications, and outcomes of colonic stent insertion at University Hospital Bristol(UHB). Method Retrospective analysis of all colonic stent procedures performed at UHB between 1st January 2010 to 31st May 2020. Results 87 patients had a colonic stent procedure. 60(69%) were performed as an emergency and 27(33%) electives. Obstruction was secondary to a tumour in 84(97%) patients and diverticular strictures in 3(3%). 19(22%) had stent insertion as a bridge to elective surgery. 64(74%) stents were successfully deployed. 15(75%) required emergency surgery where the stent was unsuccessful. Complications occurred in 9(14%) successfully deployed stents, including: perforation(1;1%); per-rectal bleed(1;1%); dislodgement(1:1%); bacterial translocation(1;1%); tenesmus(2;2%); more than one stent required(3;3%). 30-day mortality was 11%. Conclusions The majority of colonic stent procedures at UHB were for patients presenting with acute large bowel obstruction secondary to malignancy. Few of these patients were suitable for surgery and stent insertion primarily for symptom relief. Where stent insertion is unsuccessful there is a high conversion (75%) to emergency surgery. Complications were observed in 14% of stent procedures and 30-day mortality was 11%.

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Secondary colonic stent insertion in acute large bowel obstruction following primary stent failure

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0136 ◽

2020 ◽

Vol 102 (2) ◽

pp. 141-143

Author(s):

A Lazzaro ◽

A Saini ◽

C Elton ◽

GK Atkin ◽

IC Mitchell ◽

...

Keyword(s):

High Risk ◽

Bowel Obstruction ◽

Large Bowel ◽

Large Bowel Obstruction ◽

Definitive Treatment ◽

Stent Insertion ◽

Bridge To Surgery ◽

Duration Of Efficacy ◽

Colonic Stent

Introduction Colonic stent insertion has been shown to be an effective treatment for patients with acute large bowel obstruction, either as a bridge to surgery or as definitive treatment. However, little is known of the role of secondary stent insertion following primary stent failure in patients considered inappropriate or high risk for emergency surgery. Methods Fourteen patients presenting with acute large bowel obstruction who had previously been treated with colonic stent insertion were studied. All underwent attempted placement of a secondary stent. Results Technical deployment of the stent was accomplished in 12 patients (86%) but only 9 (64%) achieved clinical decompression. Successful deployment and clinical decompression of a secondary stent was associated with older age (p=0.038). Sex, pathology, site of obstruction, duration of efficacy of initial stent and cause of primary failure were unrelated to outcome. No procedure related morbidity or mortality was noted following repeated intervention. Conclusions Secondary colonic stent insertion appears an effective, safe treatment in the majority of patients presenting with acute large bowel obstruction following failure of a primary stent.

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Large bowel obstruction can be safely treated by colonic stent insertion - Case series from a UK district general hospital

International Journal of Surgery ◽

10.1016/j.ijsu.2012.06.133 ◽

2012 ◽

Vol 10 (8) ◽

pp. S25

Author(s):

Paul Blake ◽

Ray Delicata ◽

Nicholas Cross ◽

Graham Sturgeon ◽

Rachel Hargest

Keyword(s):

General Hospital ◽

Bowel Obstruction ◽

Large Bowel ◽

Case Series ◽

District General Hospital ◽

Large Bowel Obstruction ◽

Stent Insertion ◽

Colonic Stent

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Large bowel obstruction due to colorectal carcinoma can be safely treated by colonic stent insertion - case series from a UK district general hospital

Colorectal Disease ◽

10.1111/j.1463-1318.2012.03035.x ◽

2012 ◽

Vol 14 (12) ◽

pp. 1489-1492 ◽

Cited By ~ 8

Author(s):

P. Blake ◽

R. Delicata ◽

N. Cross ◽

G. Sturgeon ◽

R. Hargest

Keyword(s):

Colorectal Carcinoma ◽

General Hospital ◽

Bowel Obstruction ◽

Large Bowel ◽

Case Series ◽

District General Hospital ◽

Large Bowel Obstruction ◽

Stent Insertion ◽

Colonic Stent

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Five Year Follow-Up of a Randomized Controlled Trial on Warming and Humidification of Insufflation Gas in Laparoscopic Colonic Surgery—Impact on Small Bowel Obstruction and Oncologic Outcomes

International Surgery ◽

10.9738/intsurg-d-14-00210.1 ◽

2015 ◽

Vol 100 (4) ◽

pp. 608-616 ◽

Cited By ~ 4

Author(s):

Tarik Sammour ◽

Andrew G. Hill

Keyword(s):

Randomized Controlled Trial ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Controlled Trial ◽

Adhesion Formation ◽

Oncologic Outcomes ◽

Colonic Surgery ◽

Cancer Specific Survival ◽

Randomized Controlled

Warming and humidification of insufflation gas has been shown to reduce adhesion formation and tumor implantation in the laboratory setting, but clinical evidence is lacking. We aimed to test the hypothesis that warming and humidification of insufflation CO2 would lead to reduced adhesion formation, and improve oncologic outcomes in laparoscopic colonic surgery. This was a 5-year follow-up of a multicenter, double-blinded, randomized, controlled trial investigating warming and humidification of insufflation gas. The study group received warmed (37°C), humidified (98%) insufflation carbon dioxide, and the control group received standard gas (19°C, 0%). All other aspects of patient care were standardized. Admissions for small bowel obstruction were recorded, as well as whether management was operative or nonoperative. Local and systemic cancer recurrence, 5-year overall survival, and cancer specific survival rates were also recorded. Eighty two patients were randomized, with 41 in each arm. Groups were well matched at baseline. There was no difference between the study and control groups in the rate of clinical small bowel obstruction (5.7% versus 0%, P 0.226); local recurrence (6.5% versus 6.1%, P 1.000); overall survival (85.7% versus 82.1%, P 0.759); or cancer-specific survival (90.3% versus 87.9%, P 1.000). Warming and humidification of insufflation CO2 in laparoscopic colonic surgery does not appear to confer a clinically significant long term benefit in terms of adhesion reduction or oncological outcomes, although a much larger randomized controlled trial (RCT) would be required to confirm this. ClinicalTrials.gov Trial identifier: NCT00642005; US National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894, USA.

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