IDDF2021-ABS-0171 Long term outcomes of palliative colonic stent placement in malignant colonic obstruction: experience from a tertiary care oncology center in India

Abstract

<h3>Background</h3> Colonic Self-expanding metal stent (SEMS) placement is the preferred method for palliation of malignant colonic obstruction. We analysed outcomes of patients who underwent colonic SEMS placement for palliation at a tertiary care oncology centre in Western India. <h3>Methods</h3> A retrospective review of the endoscopy database was done for patients who underwent colonic SEMS placement at our center between January 2013 till December 2020. Demographic details, intent of stent placement, site of obstruction, length of stenosis, technical success of stenting, clinical success and complications (both immediate and long term) were noted. <h3>Results</h3> 42 patients underwent colonic SEMS placement during the study period (Mean age 54.29 years, 50% men). Obstruction was due to primary colonic malignancy in 32 (76.2%) patients. Extra-colonic malignancies leading to obstruction included Gall Bladder cancer in 6 patients, Ovarian cancer in 3 patients and pancreatic cancer in 1 patient. Site of obstruction was sigmoid colon in 15 (35.7%) patients, descending colon in 10 (23.8%), rectum and rectosigmoid in 8 (19%), distal right colon and hepatic flexure in 5 (11.9%) and transverse colon in 4 (9.5%). Metastatic disease was seen in 88.1%. Peritoneal metastases were seen in 17 (40.5%) patients. Median length of stricture was 5 cm. Technical success was achieved in 100%. Clinical success was achieved in 36 (85.7%) patients. In 3 patients, there was a clinical failure of stent placement. In 3 patients, although there was partial relief of symptoms, recurrence of obstructive symptoms occurred in less than one week. There was no correlation between peritoneal carcinomatosis and clinical success (p=0.700). Perforation during colonic SEMS placement occurred in 1 (2.4%) patient. Stent migration was seen in 3 patients, needing surgery in 2 patients. Over a median follow-up of 8 months (0-21 months), stent block was seen in 6 (14.2%) patients. Stent block developed after a median period of 6 months. Of these, one patient underwent SEMS placement within the SEMS, while others underwent surgery. <h3>Conclusions</h3> Colonic SEMS placement achieves optimal palliation of malignant colonic obstruction in 86% of patients with few complications. Long term complications like obstruction occur in few patients after a median duration of 6 months.