Colonic stenting for colorectal cancer: stoma avoidance with acceptable radiation exposure

Self-expanding metal stents (SEMS) are used to manage colonic obstruction for palliative decompression or as a bridge to curative surgery and are typically placed under fluoroscopic guidance. This study aimed to quantify the radiation exposure associated with colonic stenting for obstructing colorectal cancer (CRC) and compare it with established diagnostic reference levels (DRLs) for similar fluoroscopy-guided procedures. Secondary outcomes included procedural success rates, stent patency, stoma rates, and complications.

This retrospective observational study was conducted at a single district general hospital and included all the patients who underwent colonic stenting for CRC between March 2016 and February 2021. Radiation exposure was measured using the kerma-area product (KAP) in µGy*m² and fluoroscopy time in minutes, obtained from existing electronic patient records.

Fifty-two stenting procedures were performed in 47 patients. Median KAP was 1,373.7 (interquartile range [IQR], 584.4-3,185.2) µGy*m², and fluoroscopy time was 8.9 (IQR, 4.4-12.6) minutes. Technical and clinical success was achieved in 86.5% of the cases. In palliative cases, 88.9% of patients maintained stent patency until death. The complications included perforation (5.8%) and stent migration (3.9%). Laparoscopic surgery was performed in 70% of curative cases.

Radiation exposure during colonic stenting is within acceptable ranges and comparable to that of other fluoroscopy-guided procedures. These findings support the listing of colonic stenting in future National DRLs in the United Kingdom.