Management of Malignant Large-Bowel Obstruction

Hsu, June; Sevak, Shruti

doi:10.1097/dcr.0000000000001441

Cited by 13 publications

(14 citation statements)

References 12 publications

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“…There was one incidence of abdominal pain after SEMS insertion, but only for observing without special handling. Not all lesions are anatomically amenable to stenting, including those in the distal rectum that preclude deployment in normal bowel distal to the tumor [ 25 ], even if the stent is released and decompression successfully; the rectal irritation can also be very severe, and one patient chose to remove the stent for transverse colostomy because of serious rectal irritation symptom. Therefore, we always excluded rectal cancers within 6 to 8 cm of the anal verge in our center, except for very special and necessary cases.…”

Section: Discussionmentioning

confidence: 99%

“…The usage limitation is the high perforation rate in several randomized controlled trials [ 23 , 37 , 38 ], other complications, and environmental health threats to operators by long-term exposure under X-ray [ 1 ]. The variation in the rates of success of SEMS insertion and associated complications reported in the literature suggests that individual expertise, institutional experience, and available resources [ 25 ] have a significant bearing on the clinical application of SEMS.…”

Section: Discussionmentioning

confidence: 99%

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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

et al. 2021

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Background Placement of a self-expanding metal stent (SEMS) in patients presenting with an acute colorectal obstruction (ACO) may obviate emergency surgery (ES), potentially effectively palliating incurable tumors, acting as a bridge to surgery (BTS) in patients with operable or potentially operable tumors and achieving effective decompression of other ACO. We present our experience with SEMS insertion by colorectal surgeons without fluoroscopic monitoring for ACO especially for acute malignant colorectal obstruction (AMCO) for nearly a 14-year period (2007–2020). Aim To explore the safety and effectiveness of SEMS insertion in the management of ACO by colorectal surgeons using a two-person approach colonoscopy without fluoroscopic monitoring. Methods We reviewed the medical records of patients retrospectively 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 without fluoroscopic monitoring. Results The overall technique success rate and clinic success rate by SEMS insertion were 428/434 (98.6%) and 412/434 (94.9%). The overall incidence of complications by SEMS insertion was 19/434 (4.4%). The complications included clinical perforation (6/434, 1.4%); stent migration (2/434, 0.5%), 1 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; and abdominal or anal pain (2/434, 0.5%). There was no hemorrhage in any of the 434 patients. Conclusions SEMS insertion is a relatively safe and effective technique for colonic decompression in dealing with ACO as either a BTS or as a palliative measure. It is also a solution to other causes of ACO such as recurrent tumor, benign diseases, or extra-luminal compression. Therefore, ES was largely avoided.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…The clinical advantages of SEMS insertion in the management of ACO combined with the little negative oncological consequences makes stent a effective clinical method [4] . The limitation of the use of SEMS is the high perforation rate in several randomised controlled trials [24,33,34] , other complications, technical and clinical success rate need to improve for some units, long term exposure under X-ray environmental threats health to operators, especially young doctor [1] et al The variation in the rates of success of SEMS insertion and associated complications reported in the literature suggests that individual expertise institutional experience and available resources [26] has a signi cant bearing on the clinical application of SEMS.…”

Section: Discussionmentioning

confidence: 99%

“…There was one incidence of abdominal pain after SEMS insertion, but only for observing and the patient did not need special handling. Not all lesions are anatomically amenable to stenting, including those in the distal rectum that preclude deployment in normal bowel distal to the tumor [26] , and even if stent is released and decompression successfully, the rectal irritation can also be very severe. Many distal rectum obstruction patients who accepted stent insertion complained of obvious discomfort, and one patient chose to remove the stent for transverse colostomy because of serious rectal irritation symptom.…”

Section: Discussionmentioning

confidence: 99%

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

Yan

Zhang

Bian

et al. 2021

Preprint

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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.

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“…Surgical approaches can still be offered to patients that are being treated with palliative care in certain conditions, including no symptomatic resolution within 2-3 days following the administration of conservative treatment, only one site is obstructed, and the patient is in a suitable physical condition. 21 Besides, the chances even increase in patients suffering from benign obstruction because studies have demonstrated that the outcomes are more favorable with these patients. 7,8,14,22,23 Figure 1 summarizes the approaches that should be done when managing patients with large bowel obstruction.…”

Section: Managementmentioning

confidence: 99%

Large bowel obstruction in palliative care: overview, management and monitoring

Rahimuddin

Al-Fodari

Yatimi

et al. 2021

Int J Community Med Public Health

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Patients with pelvic and abdominal cancers usually present with bowel obstruction, especially peritoneal, colorectal, and pancreatic carcinomatosis. A poor prognosis has been reported for patients that suffer from gastrointestinal bowel obstruction secondary to later stage carcinomatosis, although maximal treatment approaches might have been administered. In this context, these patients are suggested to survive for only a few weeks to months, and parenteral nutrition did not enhance the outcomes in these situations. Medical treatment includes the administration of corticosteroids, opioids, anticholinergics, octreotide, and anti-emetics, while surgical outcomes might be more efficacious with more favorable clinical outcomes. However, these operations have been reported with multiple complications that might worsen the prognosis. Stent application is another non-surgical modality with fewer adverse events. Nevertheless, evidence regarding its superiority over the surgical approaches is conflicting among the different studies in the literature. Accordingly, further investigations are still needed for adequate validation.

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Management of Malignant Large-Bowel Obstruction

Cited by 13 publications

References 12 publications

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

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

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

Large bowel obstruction in palliative care: overview, management and monitoring

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