Application value of emergency endoscopic placement of intestinal stent for acute intestinal obstruction caused by colorectal cancer

Abstract

Objective To investigate the clinical effects of emergency intestinal stent placement on acute intestinal obstruction caused by colorectal cancer. Methods The clinical data of 37 patients with acute intestinal obstruction caused by colorectal cancer in 3 tertiary hospitals in Hunan Province from 2014 to 2018 were collected. Among them, 16 cases were from Xiangya Third Hospital of Central South University, 11 cases from the First People’s Hospital of Huaihua, and 10 cases from the First Affiliated Hospital of Hunan University of Medicine. All patients were selected for colonoscopy or stenting after the colonoscopy. Results Among the 37 patients, 1 patient underwent emergency operation because of more bleeding during enteroscopy. All the other 36 patients underwent endoscopic colon stenting. All stents were successfully placed at one time. One of the patients had not vented and defeated for three days after surgery, and the abdominal pain was aggravated. The plain film of the abdomen indicated the free gas under the armpit in the patient, so the emergency operation was performed. Another 1 patient had stent placement again 5 days after operation for displacement; and the other patients started feeding water on the next day after surgery, without any discomfort or intolerance to the stent. There were no complications such as perforation, gastrointestinal bleeding and abdominal pain. The stent placement time was 30 to 90 minutes, with an average of 40 minutes. The success rate of stent placement was 97.3%, and the clinical success rate was 94.3%. After obstructive symptoms were gradually relieved, 16 patients underwent secondary surgery, 19 patients underwent conservative treatment. During the follow-up of 6 to 48 months, 3 of 16 patients who underwent secondary surgery had late tumor stage, and tumor recurred for without radiotherapy and chemotherapy which was not in accordance with medical advice. The other 13 patients who underwent second-stage surgery after removal of the colonic stent had no tumor metastasis or recurrence. Of the 19 patients who underwent conservative treatment, 13 patients died due to multiple tumor metastases, and the other 6 patients were still under follow-up. Conclusions Emergency endoscopic placement of intestinal stent for acute intestinal obstruction caused by colorectal cancer is safe and effective. Variable emergency surgery is a flat surgery, which can significantly reduce the mortality and stoma rate of patients. It is also a safe and simple treatment for patients with advanced palliative care, which can greatly improve the quality of life. Key words: Self-expanding metal stent; Acute intestinal obstruction; Emergency endoscopy; Palliative treatment