Colorectal stenting in England: a cross-sectional study of practice

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Interventional Radiology

Background:

• UK and European guidelines suggest self-expandable metallic stents (SEMS) as an alternative to emergency surgery for left-sided colonic obstruction.
• Concerns regarding complications and long-term outcomes have led to a lack of consensus on SEMS implementation.
• This study is the first to investigate the provision of SEMS across England.

Purpose of the Study:

• To explore the current service provision of self-expandable metallic stents (SEMS) for colonic obstruction in England.
• To identify variations in stenting practices, including referrals, timing, location, and involved specialties.
• To understand the challenges and potential solutions for optimizing SEMS availability and expertise.

Main Methods:

• A questionnaire was distributed to colorectal surgery department leads across all English hospitals in 2018.
• The questionnaire gathered data on service provision for colorectal stenting, including referrals, timing, location, and specialty involvement.
• Responses were analyzed to determine current practices and identify areas of variation.

Main Results:

• All surveyed hospitals consider SEMS for colonic obstruction, with 92% performing stenting procedures.
• The majority of hospitals (93%) perform fewer than four stenting procedures monthly, primarily during standard weekday hours.
• Stenting occurs in radiology (64%), endoscopy (44%), and operating theatres (15%), involving surgeons (63%), radiologists (60%), and gastroenterologists (48%).

Conclusions:

• While all hospitals consider SEMS for colonic obstruction, significant variations in practice exist regarding access and expertise.
• Challenges in stenting provision highlight the need for improved standardization and support.
• Centralization and regional referral networks are proposed as potential strategies to enhance SEMS availability and expertise.