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

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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Does the diameter of colonic stent influence the outcomes in bridge-to-surgery patients with malignant large bowel obstruction?

Surgery Today ◽

10.1007/s00595-020-02185-2 ◽

2020 ◽

Author(s):

Akihisa Matsuda ◽

Takeshi Yamada ◽

Goro Takahashi ◽

Tetsutaka Toyoda ◽

Satoshi Matsumoto ◽

...

Keyword(s):

Bowel Obstruction ◽

Large Bowel ◽

Large Bowel Obstruction ◽

Bridge To Surgery ◽

Colonic Stent

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Sa1544 Risk Factors for Complications After Colonic Stent Insertion for Large Bowel Obstruction

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2014.05.162 ◽

2014 ◽

Vol 79 (5) ◽

pp. AB250

Author(s):

Jensen T. Poon ◽

Steffi Yuen ◽

Dominic Foo ◽

Wai-Lun Law

Keyword(s):

Risk Factors ◽

Bowel Obstruction ◽

Large Bowel ◽

Large Bowel Obstruction ◽

Stent Insertion ◽

Colonic Stent

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689 A Service Evaluation of Colonic Stent Procedures Over A 10 Year Period at University Hospital Bristol

British Journal of Surgery ◽

10.1093/bjs/znab259.412 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

Y Embury-Young ◽

F Caslake Holding ◽

E Wates ◽

J Shabbir

Keyword(s):

Bowel Obstruction ◽

Emergency Surgery ◽

Large Bowel ◽

Elective Surgery ◽

Symptom Relief ◽

Service Evaluation ◽

Large Bowel Obstruction ◽

University Hospital ◽

Stent Insertion ◽

Colonic Stent

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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A Clinical Evaluation of Endoscopicallyplaced Self-Expanding Metallic Stents in Patients with Acute Large Bowel Obstruction

Scandinavian Journal of Surgery ◽

10.1177/145749690909800303 ◽

2009 ◽

Vol 98 (3) ◽

pp. 143-147 ◽

Cited By ~ 21

Author(s):

H.-C. Pommergaard ◽

P. Vilmann ◽

H. L. Jakobsen ◽

M. P. Achiam

Keyword(s):

Mortality Rate ◽

Bowel Obstruction ◽

Large Bowel ◽

Clinical Success ◽

Large Bowel Obstruction ◽

Metallic Stents ◽

Safe Procedure ◽

Bridge To Surgery ◽

Mortality And Morbidity

Background and Aims: Self-expanding metallic stents (SEMS) have since 1991 established themselves as an option in the treatment of large bowel obstruction. The aim of this study was to evaluate the use of SEMS in management of acute colorectal obstructions at a Danish Surgical Gastroenterology center. Material and Methods: Retrospective review of charts from all patients who, in the period Marts 2002 to December 2007 underwent insertion of a SEMS for an acute large bowel obstruction. Results: Of 45 patients included, SEMS was intended as a bridge to surgery in 20 patients and as palliation in 25 patients. For malignant etiology, the SEMS procedure was a technical and clinical success in 97.4% of the cases. Complications occurred in 21%, mortality rate 2,6%. For benign etiology, the SEMS procedure was a technical success in 85.7%, and a clinical success in 71.4%. Complications occurred in 71.4% of the benign cases with a mortality rate of 28,6%. Conclusions: placement of SEMS for acute large bowel obstruction with malignant etiology is an effective and safe procedure with low mortality and morbidity. However results for benign obstructions are questionable and more research is needed to determine the role of SEMS.

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