Endoscopic Self-Expandable Metallic Stent Insertion without Fluoroscopic Guidance Is Feasible and Safe for Acute Colonic Obstruction Caused by Colorectal Cancer.

Yadong Feng,Ruihua Shi,Qian Yu,Ye Zhu,Wei Xu,Ming Li,Yang Liu

doi:10.1155/2020/6810164

Yadong Feng, Ruihua Shi + Show 5 more

Open Access

https://doi.org/10.1155/2020/6810164

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Abstract

Aims Endoscopic self-expandable metallic stent (SEMS) insertion for acute colonic obstruction caused by colorectal cancer (CRC) is always performed under fluoroscopic guidance. This study evaluated the feasibility and safety of an endoscopic stenting procedure without fluoroscopic guidance. Methods A total of 36 patients with an acute colonic obstruction caused by CRC underwent endoscopic SEMS insertion using a colonoscope without fluoroscopic guidance, followed by analyses of the technical and clinical success and short-term complications. Results Total technical success rate and clinical success rate were 91.7% and 86.1%, respectively. The mean procedure time was 21.2 ± 10.3 minutes. There was no stent dislodgement. One case of hematochezia and two cases of tenesmus occurred in patients with left-sided complete obstructions. No other short-term complications occurred. Procedure time, technical success, and clinical success rate were 16.3 ± 9.4 minutes, 93.1%, and 89.6% for left-sided obstructions, respectively, and were 26.8 ± 10.7 minutes, 85.7%, and 71.4% for right-sided obstructions, respectively. For complete obstructions, procedure time, technical success, and clinical success rate were 22.5 ± 8.9 minutes, 90%, and 83.3%, respectively. In the incomplete cases, procedure time, technical success, and clinical success were 13.5 ± 6.7 minutes, 100%, and 100%, respectively. Technical success, clinical success, and short-term complications were not differed between lesion locations and degrees. Conclusions This simple technique is feasible and safe for palliation of acute colonic obstruction caused by CRC.

Highlights

Acute colonic obstruction occurs in approximately 7%–29% of patients with colorectal cancer (CRC) [1, 2]
If fluoroscopy was in a full schedule, emergency colonic stenting for patients with an acute colonic obstruction in a combined endoscopic and fluoroscopic approach may be delayed; even some patients may be treated with emergency laparotomy or open surgery [6]
Twenty-nine patients had an obstruction at the left-sided colon, and the remaining seven patients had a right-sided colon obstruction

Summary

Introduction

Acute colonic obstruction occurs in approximately 7%–29% of patients with colorectal cancer (CRC) [1, 2]. Endoscopic insertion of self-expanding metallic stents (SEMS) is an established treatment for CRC-induced acute colonic obstruction [4]. If fluoroscopy was in a full schedule, emergency colonic stenting for patients with an acute colonic obstruction in a combined endoscopic and fluoroscopic approach may be delayed; even some patients may be treated with emergency laparotomy or open surgery [6]. If nonradiation stenting insertion was technically feasible, patients with a CRC-induced acute colonic obstruction will get more benefits from a timely stenting. Since endoscopic stenting is an image-guiding procedure, characteristics of preprocedural imaging make it possible for SEMS insertion for CRC-induced acute colonic obstruction with a therapeutic colonoscopy only. We conducted emergency SEMS insertions for acute colonic obstruction caused by CRC using endoscopic approach without fluoroscopy guidance. Male (%) Female (%) Age (years) Obstruction location Left-sided colon (%) Right-sided colon (%) Complete obstruction (%) Stricture length (cm)

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