Low morbidity and mortality after stenting for malignant bowel obstruction

Area of Science:

• Gastroenterology
• Surgical Oncology
• Interventional Endoscopy

Background:

• Malignant colonic obstruction presents a significant mortality risk, especially in older patients, with emergency surgery carrying a higher risk than elective procedures.
• Emergency surgery for colonic obstruction can be averted through endoscopic interventions like self-expandable metal stent (SEMS) placement.

Purpose of the Study:

• To assess the efficacy and safety of using SEMS as a 'bridge to surgery' for malignant colonic obstruction.
• To compare the risks associated with SEMS placement versus emergency surgery for colonic malignancy.

Main Methods:

• A cohort of 45 patients with acute malignant colonic obstruction underwent SEMS placement between January 2001 and July 2008.
• Patient demographics included a median age of 72 years, with a range of 35-91 years.

Main Results:

• Technical success for SEMS placement was achieved in 94% of patients (43/45), resolving obstructive symptoms in 87% within 48 hours.
• The procedure demonstrated a low complication rate, with no perforations and a postoperative mortality of 2.2% (1 patient).
• All patients successfully underwent single-stage surgery, with 75% diagnosed with advanced colorectal cancer (T3-4N1-2M0-1).

Conclusions:

• SEMS placement is a safe and effective endoscopic strategy for managing colonic obstruction due to malignancy, serving as a crucial 'bridge to surgery'.
• This interventional approach significantly reduces the risks associated with emergency surgery, offering a safer alternative for high-risk patients.