Self-Expanding Metal Stent Insertion by Colorectal Surgeons Using a Two-Person Approach Colonoscopy Without Fluoroscopic Monitoring in the Management of Acute Colorectal Obstruction: A 14-Year Experience

Background Placement of a self-expanding metal stent (self-expanding metal stent, SEMS) in patients presenting with kinds of colorectal disease as an acute colorectal obstruction (acute colorectal obstruction, ACO) may obviate emergency surgery(emergency surgery, ES), potentially effectively palliating incurable tumours, acting as a bridge to surgery (bridge to surgery, BTS) in patients with operable or potentially operable tumours and achieving effective decompression of other colorectal obstruction diseases. We present our experience with SEMS insertion by colorectal surgeons without fluoroscopic monitoring for ACO especially for acute malignant colorectal obstruction (acute malignant colorectal obstruction, AMCO) nearly a 14-year period (2007–2020).Methods We retrospectively reviewed the medical records of patients to identify all patients presenting to our unit with ACO especially with AMCO who had stenting carried out to achieve colonic decompression. All 434 procedures were performed by colorectal surgeons using a two-person approach colonoscopy and a conventional endoscope without fluoroscopic monitoring. Results The overall technique success rate by SEMS insertion was (428/434, 98.6%), the overall clinic success rate by SEMS insertion was (412/434, 94.9%), and the overall incidence of complications was (19/434, 4.4%). The complications included clinical perforation (6/434, 1.4%), stent migration (2/434, 0.5%), one of which re-stent; stent detachment (fell off)(3/434, 0.7%), none of them with re-stent; stool impaction (6/434, 1.4%), 1 of which re-stent; abdominal pain or anal pain (2/434, 0.5%). There was no hemorrhage in any of the 434 patients. Conclusions SEMS insertion is a relative safe and effective technique for colonic decompression in the dealing with ACO as either a bridge to subsequent resection surgery or as palliative measure, or solution to other causes such as recurrent tumor、benign diseases or extra-luminal compression. Therefore, ES was largely avoided.

Biopsy sampling during self-expandable metallic stent placement in acute malignant colorectal obstruction: a narrative review

Background Histopathology is a crucial part of diagnosis and treatment guidance of colorectal cancer. In Denmark, it is not routine to biopsy during self-expandable metallic stent (SEMS) placement as a treatment option for acute colorectal obstruction of unknown etiology. This is due to lack of knowledge about the risks of hemorrhage, and thus the risk to aggravate the deteriorating overview conditions. Therefore, the aim of this study is to investigate whether there is evidence to avoid biopsy sampling during acute SEMS placement. Methods The PubMed, Embase, and Cochrane Library databases were searched for relevant studies. Studies were included if they described biopsy sampling in relation to SEMS placement. Additionally, national and international guidelines were scrutinized on Google and by visiting the websites of national and international gastrointestinal societies. Results In total, 43 studies were included in the review. Among these, one recommended biopsy during SEMS placement, three advised against biopsy, 23 just reported biopsy was performed during the procedure, and 16 reported biopsy before or after the procedure, or the timing was not specified. Among the 12 included guidelines, only two described biopsy during SEMS placement. Conclusion The literature on the subject is limited. In 24 of the 43 included studies, biopsy sampling was done during SEMS placement without reporting a decrease in the technical success rate. The included guidelines were characterized by a general lack of description of whether biopsy during SEMS placement should be performed or not. Prospective studies are needed in order to establish the real risk of hemorrhage, if any, when a biopsy is obtained.