Endoscopic stent placement in the management of malignant colonic obstruction: Experiences from two centers
Bünyamin Gürbulak1, Esin Kabul Gürbulak2, İsmail Ethem Akgün2, Kenan Büyükaşık1, Hasan Bektaş1
1Clinic of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
2Clinic of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
Objective: Intestinal obstruction due to colorectal tumors requires immediate surgical decompression. Endoscopic stent placement for acute malignant colonic obstruction is gaining widespread acceptance as an alternative to emergency surgery. Our aim in this study was to evaluate the success and complication rates of endoscopic stenting for malignant colonic obstruction.
Material and Methods: Patients with acute malignant colonic obstruction who underwent endoscopic stenting between 2011-2014 were retrospectively reviewed. Data included demographic features, localization of obstruction, endoscopic stenting indications, rate of technical and clinical success, complications, morbidity and mortality.
Results: Endoscopic stent was successfully placed in 77 out of 82 procedures (93.9%). A colostomy was placed in five cases in which endoscopic stent could not be inserted. There were complications in seven patients with technically successful stents (9.0%). These included three stent migrations, one perforation, and rectal hemorrhage in three patients. There were no stent-related deaths.
Conclusion: The mortality rate of emergency surgery for malignant bowel obstruction is relatively high. The use of colonic stents can avoid surgery in patients who are not suitable for emergency surgery and may allow adequate time for preoperative preparation, counseling and staging for those who are suitable for further intervention. We believe that self-expandable metallic stent placement is a safe, effective, and minimal invasive alternative treatment method for malignant colonic obstruction.
Keywords: Colorectal carcinoma, self-expandable colonic stent, malignant intestinal obstruction
Ethical approval has not been received in this study, which was designed retrospectively by scanning open access patient data in computer in general surgery clinics.
Informed patient consent form including the disease and colonoscopic stent insertion procedure was obtained from all patients included in this study.
Concept - B.G., E.K.G., İ.E.A.; Design - B.G., E.K.G., H.B.; Supervision - H.B.; Funding - B.G., E.K.G.; Materials - B.G., E.K.G.; Data Collection and/or Processing - B.G., E.K.G.; Analysis and/or Interpretation - B.G., E.K.G., İ.E.A., K.B., H.B.; Literature Review - B.G., E.K.G., H.B.; Writer - B.G., E.K.G.; Critical Review - B.G., E.K.G., İ.E.A., K.B., H.B.; Other - B.G., E.K.G.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.