Management of large bowel obstruction with self‐expanding metal stents. A multicentre retrospective study of factors determining outcome

Geraghty, Joe; Sarkar, S; Cox, Trevor F.; Lal, Simon; Willert, Robert P.; Ramesh, Jayapal; Bodger, Keith; Carlson, Gordon L

doi:10.1111/codi.12582

Cited by 58 publications

(49 citation statements)

References 28 publications

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“…15 As with all technical procedures, there is a learning curve for colonic SEMS placement. Retrospective series 22,28 and noncomparative studies 29,30 have shown that stent outcome is affected by operator experience. Technical success rate (and use of fewer stents) significantly improves after 20 procedures.…”

Section: 27mentioning

confidence: 99%

Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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Acute colonic obstruction secondary to left-colonic malignancy remains a common emergency condition. Traditional management is emergency surgery and has high morbidity and mortality. Self expandable metallic stents (SEMS) promised to improve morbidity and mortality, stoma rates and hospital stay. SEMS use in the potentially curative setting, as a bridge to surgery, is associated with an improved stoma rate and morbidity, but has no mortality benefit. There are concerns about oncological safety with higher local recurrence rates, thus SEMS is not recommended in this setting unless the patient has increased surgical risk and would benefit from a period of recovery prior to surgery. SEMS has a definite role in the palliative setting, for both patients with incurable disease or those with a high surgical risk. SEMS is associated with improved morbidity, mortality, and stoma rates. The technique for SEMS insertion is now well established but it is still unclear whether covered or uncovered stents are better.

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Section: 27mentioning

confidence: 99%

Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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“…Perforation rate ranged from 0 to 83%; the overall risk of perforation was about 5%, which is a relatively low risk, but the mortality rate of patients with perforations was 16% [28] . CS technical and clinical success are dependent on Endoscopist's experience: Geraghty reported that technical success and good outcome for the emergency management of ALBO by SEMS insertion did not vary by indication or site of obstruction but it is higher for experienced operators who had performed more than 10 procedures, using the through-the-scope (TTS) endoscopy technique [29] . Giannotti evaluating prospectively short and long term results from CS concluded that the interpretation of CS benefits may be ascribed to the experience of the endoscopist and the relatively low rate of complete colonic obstructions [30] .…”

Section: Risk Of Perforation After Sems Insertionmentioning

confidence: 99%

Colonic Stenting in the Management of Acute Left-sided Malignant Colonic Obstruction is Oncologically Safe?

Belinda

Catena

2017

Journal of Tumor

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stoma creation in comparison with emergency surgery, enhancing patients' quality of life, without differences in terms of mortality and morbidity rate. According to available data, at one year follow up time, the recurrence rate is higher in patients treated with stent, with no statistical difference in terms of disease free survival and overall survival. Endoscopist's experience, type of colic obstruction (partial or total), type of stent, insertion technique and timing of surgery are fundamental to reach CS technical and clinical success. Oncologic (un)-safety of colonic stenting has to be still investigated and confirmed by medium and long term follow up of large prospective studies and randomized controlled trials comparing SEMS as bridge to surgery and ES. CS can be strongly considered with palliative intent in patients with advanced neoplastic disease, to avoid stoma and health care costs related to stoma.

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“…The application of SEMS has recently become more frequent for the palliation of metastatic colorectal cancer and as a bridge to surgery for obstructing tumors, despite the concerns regarding safety and efficacy in recent systematic reviews and meta-analyses (6,7). Additional considerable variations in practice may exist due to the lack of expertise and technical difficulties (8,9). …”

Section: Introductionmentioning

confidence: 99%

“…The wire is manipulated with either fluoroscopy alone, as in the over-the-wire (OTW) method, or combined with endoscopic visualization, as in the through-the-scope (TTS) technique (8,10). In the literature, it appears that experienced operators using TTS achieved better technical and clinical outcomes (8,9,11,12). The present study demonstrated that TTS is a practical tool for effectively resolving bowel obstruction in our unit.…”

Section: Introductionmentioning

confidence: 99%

Observational study of colonoscopy techniques used for acute colorectal obstruction: A single-center experience

Chen

et al. 2017

Molecular and Clinical Oncology

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The prevalence of acute colorectal obstruction at the hospital setting is high. There is need for improvement in the quality of colonoscopy for relieving obstruction. A retrospective, uncontrolled, open-label study was conducted, with the aim of documenting the causes of acute colorectal obstruction and the quality of colonoscopy practice in managing obstruction at a university hospital in China. A total of 61 adult patients with acute colorectal obstruction treated with urgent colonoscopy between February, 2011 and January, 2016 were identified at the Endoscopic Unit of Tongji Hospital (Wuhan, China). The technique success rate was the primary outcome. The etiology was mainly related to malignant diseases, including colorectal cancer in 53 patients (86.9%) and advanced peritoneal serous carcinoma leading to extrinsic colonic compression in 1 patient (1.6%). Benign causes of obstruction included foreign bodies in 3 patients (4.9%) and fecal impaction in 2 patients (3.3%); furthermore, anastomotic strictures were found in 2 patients (3.3%). The technique success rate was 98.4% (60/61). All colorectal cancer patients who underwent urgent colonoscopy were admitted to the Department of Surgery for placement of a self-expanding metallic stent; 1 patient who had an extracolonic malignancy underwent placement of a transanal colonoscopic decompression tube as palliative therapy and 2 patients with anastomotic strictures underwent endoscopic balloon dilation. Furthermore, colonoscopy was used for extracting the foreign body, as well as removing fecal stones in all the patients. In conclusion, urgent colonoscopy as a minimal invasive approach is associated with certain advantages for diagnosing and managing acute colorectal obstruction. Furthermore, experienced operators achieved a better outcome when managing colorectal obstruction.

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Management of large bowel obstruction with self‐expanding metal stents. A multicentre retrospective study of factors determining outcome

Abstract: Experienced operators using a TTS technique achieved a better outcome for the emergency management of large bowel obstruction. Older, sicker patients and those with extracolonic and benign strictures fared less well.

Cited by 58 publications

References 28 publications

Colonic cancer: The current role of stent insertion

Colonic cancer: The current role of stent insertion

Colonic Stenting in the Management of Acute Left-sided Malignant Colonic Obstruction is Oncologically Safe?

Observational study of colonoscopy techniques used for acute colorectal obstruction: A single-center experience

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