Su1710 ENDOSCOPIC MANAGEMENT OF MALIGNANT LARGE BOWEL OBSTRUCTION: A SINGLE-CENTER, COMMUNITY-BASED STUDY

Abstract

Colonic stents are used to relieve large bowel obstruction in the setting of primary or metastatic colonic malignancy. Self-expandable metal stents (SEMS) are indicated as a bridge to elective surgery (BTS) allowing for thorough preoperative colonoscopy and to enable a primary anastomosis after resection without the need for a temporary colostomy. They are also indicated for palliative treatment of patients who are inoperable. We sought to better understand the clinical patterns of colonic stent insertion as this technique becomes more widely available in the community setting. All patients who underwent colonic stent placement for large bowel obstruction due to malignancy at New York-Presbyterian Queens between January 2011 and April 2017 were retrospectively reviewed. Demographic characteristics, tumor pathology, surgical follow up, colonic location of stenosis, technical success rate, clinical success, complications, in-hospital mortality and 30-day readmission rate were evaluated. 64 patients underwent colonic stenting for large bowel obstruction as diagnosed by radiographic imaging. 3 patients received multiple stents. Mean age was 72. (range 33-98). Forty (62%) were male and 24 were female (38%). 49 (77%) were primary colon or rectal carcinoma; 11 (17%) were metastatic lesions with extrinsic compression. Diagnosis was undetermined in 4 patients (6%). The majority of obstructions occurred in the sigmoid colon (43%) (Table 1). Eighty-five percent of colonic stents were placed in the left colon, and 15% on the right. Stent placement was successful in 63 patients (98%). There were 3 stent failures (two left sided and one right sided occlusion). One patient had a left sided perforation requiring emergent exploratory laparotomy. There were no deaths caused directly by stent placement. Surgery was performed in 33 out of 64 patients (52%), whereas 48% were palliative. There was no difference in outcome in terms of successful stent deployment, in-hospital mortality or 30-day readmission rate between primary colorectal lesions and metastatic lesions. There was no significant difference in complication rate or 30-day readmission rate between BTS and palliative groups. Colonic stenting is a safe and effective procedure for relief of large bowel obstruction for palliation or as a BTS in a community hospital setting. Our study showed a relatively low complication/stent failure rate (2% perforation and 5% stent occlusion) for both left and right colon lesions. Stenting of extrinsic compressing lesions appears to be safe and effective.