Feasibility and safety of colonic flexural stenting: a comparative analysis

Colonic stenting for malignant large bowel obstruction (LBO) is established as an effective option for palliation and bridging to more definitive surgery. However, stenting of flexural tumours (hepatic or splenic) is comparatively technically challenging due to colonic angulation and tortuosity. To assess its relative safety and feasibility we have analysed its outcomes against stenting elsewhere in the colon. Retrospective data, including baseline demographics, mortality/morbidity data, and patency rates, were collected on patients diagnosed with malignant LBO at our centre between August 2007 and August 2024. Colonic stenting was performed by advanced endoscopists with fluoroscopic guidance. Malignant flexural and non-flexural stenting outcomes were compared through chi-squared testing and Kaplan-Meier analysis using SPSS. A total of 86 patients underwent colonic stenting, with 13 patients stented in the colonic flexures. Comparison of outcomes between flexural and non-flexural stenting revealed no statistically significant differences. Primary patency at 90 days was higher in the flexure group (69.23%) compared to the non-flexure group (46.15%) (p = 0.195). Kaplan-Meier analysis showed a median primary patency of 164 days (95% CI: 70-258) for flexural stenting and 98 days (95% CI: 13-183) for non-flexural stenting (p = 0.453). No statistically significant difference was found between the two groups in terms of the stent-related complications of migration, re-stenosis and perforation. Flexural colonic stenting for malignant LBO does not appear to be inferior to stenting elsewhere in the colon, highlighting its potential safety and feasibility in experienced hands. Flexural colonic stenting may be considered an option in the management of malignant LBO, for both palliation and bridging.