Abstract
BackgroundEmergency surgery for large bowel obstruction carries significant morbidity and mortality. After initially promising results, concerns have been raised over complication rates for self-expandable metal stents (SEMS) in both the palliative and bridge-to-surgery settings. This article documents the technique used at the authors' institution, and reports on success and complication rates, as well as identifying predictors of endoscopic reintervention or surgical treatment.
MethodsData were collected for a prospective cohort of consecutive patients undergoing attempted colonoscopic SEMS insertion at a single institution between 1998 and 2013. Multivariable logistic models were fitted to assess possible predictors of endoscopic reintervention and surgical treatment.
ResultsPalliative SEMS insertion was attempted in 146 patients. Primary colorectal cancer was the most common cause of obstruction (952 per cent). The majority of patients (774 per cent) were treated in an acute setting, with a high technical success rate of 973 per cent. The perforation rate was 48 per cent and the 30-day procedural mortality rate 27 per cent. No predictors of early complications were identified, although patients with metastases and those who received chemotherapy were more likely to have late complications. Some 308 per cent of patients required at least one further intervention, with 110 per cent of the cohort requiring a stoma. Endoscopic reintervention was largely successful.
ConclusionSEMS offer a valid alternative to operative intervention in the palliative management of malignant large bowel obstruction. Patients receiving chemotherapy are more likely to receive endoscopic reintervention, which is largely successful.
Successful in the majority