Stenting as a bridge to surgery for extra-colonic malignancy induced colorectal obstruction: preliminary experience

Abstract

Background: The majority of colonic obstructions result from colorectal cancer. However, malignancies of extracolonic origin can also disrupt colorectal patency, and the efficacy of self-expanding metal stents (SEMS) insertion as a bridge to surgery in these patients are still in debate. The aim of this study is to evaluate the efficacy of endoscopic stenting as a bridge to surgery (BTS) for extra-colonic malignancy (ECM)-induced colonic obstruction. Methods: Thirty-three patients with colonic obstruction due to ECM who received self-expanding metal stents (SEMS) insertion at a single academic tertiary medical center between 2004 and 2015 were included. The purpose of SEMS insertion was determined based on whether the patient's medical records indicated any surgical plans before SEMS insertion. Technical success was defined as a patent SEMS covering the entire length of the obstruction. Bridging success was defined as elective surgical procedures after the first SEMS insertion. Results: Among the 33 patients who underwent SEMS insertion for colorectal obstruction due to ECM, nine underwent SEMS as a BTS. Technical success was achieved in 100% (9/9). Seven patients underwent elective surgery after successful decompression with the first SEMS, and the bridging success rate was 77.8% (7/9). Two patients needed secondary stent insertion before elective surgery. However, none of them required emergent surgery. No major complications occurred, including death related to colorectal endoscopic procedures, perforation, or bleeding. Conclusion: SEMS insertion as a BTS is a good treatment option to avoid emergent surgery in patients with colonic obstruction caused by extra-colonic malignancy.

AGA Clinical Practice Update on the Optimal Management of the Malignant Alimentary Tract Obstruction: Expert Review

“…No SEMS-related AEs were seen in that study. 63 Best Practice Advice 14 SEMS placement is a reasonable alternative for patients with ECM who are not candidates for surgery, although their placement is more technically challenging, clinical success rates are more variable, and complications (including stent migration) are more frequent.…”

Short-term outcomes after self-expandable metal stent insertion for obstructing colon cancer: a retrospective cohort study

“… 3 With advancements in technology, SEMS are now used as a bridge to curative surgery. 2 However, concerns about using SEMS were raised since there are serious complications associated with their usage that affect survival. 3 Various studies report complications of SEMS, namely perforation (4.5%), migration (11%), and obstruction (12%).…”