Shifting practice: Moving to a stent first approach for both left and right sided acute malignant large bowel...

To assess the safety and efficacy of a change to a stent first approach for malignant large bowel obstruction (LBO) in both left and right colon in a single centre over a 4-year period.

This retrospective cohort study in an acute NHS Hospital Trust from 01/01/2019-31/12/2022 examines a change in practice from emergency surgery (ES) to colonic stenting for patients with both left and right sided acute malignant LBO. Co-primary outcomes were clinically successful bowel decompression following stenting and 30-day mortality. Secondary outcomes were length of stay, stent complications, stoma formation and minimally invasive surgery (MIS).

68 patients underwent colonic stenting, and 29 patients underwent primary ES for acute malignant LBO. Stenting achieved successful bowel decompression in 77.9%. 30-day mortality for those initially stented was 7.4% and for ES 6.9%. In palliative patients initially treated with stenting the stoma rate was lower (15.4 vs. 100.0%) with a reduced rate of open surgery (5.1 vs 87.5%) when compared to ES. In curative patients initially treated with stenting the stoma rate was lower (37.9 vs. 80.1%) with an increased rate of MIS (69.0 vs 19.0%), when compared to ES. 27.9% of patients underwent stenting proximal to the splenic flexure.

It is possible to offer colonic stenting to > 80% of patients presenting with acute malignant LBO despite not having a 24/7 rota. There was a reduced rate of stoma formation, open surgery and length of stay in both palliative and curative patients undergoing primary colonic stenting.