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

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

Colorectal Disease ◽

10.1111/codi.13951 ◽

2018 ◽

Vol 20 (4) ◽

pp. 288-295 ◽

Cited By ~ 2

Author(s):

C. J. Young ◽

A. Zahid

Keyword(s):

Randomized Controlled Trial ◽

Bowel Obstruction ◽

Large Bowel ◽

Controlled Trial ◽

Large Bowel Obstruction ◽

Stent Insertion ◽

Randomized Controlled ◽

Colonic Stent

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Metallic stents in large bowel obstruction: experience in a District General Hospital

Colorectal Disease ◽

10.1111/j.1463-1318.2004.00697.x ◽

2005 ◽

Vol 7 (1) ◽

pp. 22-26 ◽

Cited By ~ 16

Author(s):

Wing-Kin Syn ◽

M. Patel ◽

M. M. Ahmed

Keyword(s):

General Hospital ◽

Bowel Obstruction ◽

Large Bowel ◽

District General Hospital ◽

Large Bowel Obstruction ◽

Metallic Stents

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Simultaneous passage of ultra-slim colonoscope and colonic stent catheter across left-sided colonic stent for placement of a hepatic flexure stent for malignant large-bowel obstruction

VideoGIE ◽

10.1016/j.vgie.2017.06.008 ◽

2017 ◽

Vol 2 (10) ◽

pp. 270-271

Author(s):

Ikenna Anaka ◽

Hiren Vallabh ◽

Sardar Shah-Khan ◽

John Nasr

Keyword(s):

Bowel Obstruction ◽

Large Bowel ◽

Large Bowel Obstruction ◽

Hepatic Flexure ◽

Colonic Stent

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COLORECTAL CARCINOMA;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.03.989 ◽

2013 ◽

Vol 20 (03) ◽

pp. 472-477

Author(s):

MOHAMMAD ADNAN NAZEER ◽

QAMAR SHAHZAD ◽

HARUN MAJID DAR ◽

Asma Samreen ◽

Humaira Aalam

Keyword(s):

Colorectal Carcinoma ◽

Bowel Obstruction ◽

Large Bowel ◽

Standing Position ◽

Large Bowel Obstruction ◽

Sigmoid Volvulus ◽

Colorectal Cancers ◽

Fluid Interfaces ◽

Biochemical Tests ◽

Age Range

Introduction: Large bowel obstruction due to colorectal carcinoma occurs in up to 20% of the patients and usually2-4 accompanied by morbidity and mortality . Almost 25 % deaths occur post-operatively following surgery for colorectal cancers occur in1 those who initially present with obstruction . Usually elderly patients with associated co-morbidities presents with bowel obstruction.Objective: Find out the frequency of colorectal cancers in patients presenting with large bowel obstruction. Design: Prospective crosssectional study. Setting: Shaikh Zayed Hospital Lahore. Period: from 31st December 2010 to 31st December 2012. Materials &Methods: A total 20 patients were presented with large bowel obstruction with the age ranges between 40 to 70 years. All the 20 patientsunderwent routine haematological and biochemical tests. In these patients an abdominal x-ray in a supine or standing position was takenand dilated loops of bowel, air-fluid interfaces, or both was observed then Contrast radiography(Barium/gastrograffin) was done todefine the site and extent of the obstruction. An abdominal computed tomography scan was done to evaluate the extent of the disease.Colonoscopy was also carried out in the patients with colorectal cancers to find out the size and location of the tumor and biopsy taken bycolonoscope. Results: 12 patients out of 20 presented with large bowel obstruction were diagnosed to have a colorectal cancers and theage ranges from 60 to 70 years. The 8 patients were diagnosed to have a sigmoid colonic tumour and 4 patients were suffering from atumour of recto sigmoid junction. Whereas in rest of the 8 patients the large bowel obstruction was due to other benign causes likevolvulus and intussusception and age range was 50 – 60 years. 6 patients were suffering from sigmoid volvulus and remaining 2 hadcolo-colic intussusception. Conclusions: It is concluded that the major cause of the large bowel obstruction is the left sided colorectalcancers the tumours of recto sigmoid junction.

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