Colonic self-expanding metal stents (SEMS) in acute large bowel obstruction

Colonic SEMS are increasing used in the management of acute large bowel obstruction, both as a bridge to surgery and as a definitive palliative measure in patients unfit for surgery. We describe our experience from a New Zealand hospital and compare our data with that already published in literature.

In this retrospective 4-year study, data was collected from the case notes of 28 consecutive patients with acute large bowel obstruction referred for colonic SEMS. Uncovered Boston Scientific colonic SEMS were placed endoscopically under fluoroscopic guidance. Technical success was considered as correct placement of stent after deployment and clinical success as the passage of flatus and faeces after stent insertion. Data was analysed using descriptive statistics.

Our technical and clinical success rates were 90% and 88% respectively. The procedure was palliative in 15 patients and as a bridge to elective surgery in 13 cases. Procedure-related mortality was 7%. It was because of one early and one late perforation. The average length of stay post procedure was 2 days. Mean survival post stent insertion in the palliative group was 2.4 months and for those with a bridge to surgery was 14 months.

n Our results support the data published from international centres in terms of deployment of SEMS in patients with acute large bowel obstruction, both as a bridge to surgery and as a definitive palliative measure.