Abstract
To assess the factors contributing to the technical and clinical success of colorectal stenting for large bowel obstruction. 268 cases of colonic stenting for large bowel obstruction were performed in 249 patients of mean age of 72years (28-98) between 2006 and 2013. The majority of strictures were due to malignant disease, 244/268 (91%). Diverticular strictures accounted for 24/268 (9%). Overall technical success rate was 81% (217/268), with a clinical success rate of 65% (174/268). Duration of symptoms ranged from 0 to 180days (mean 8days). Technical success rate was seen to decrease with increasing symptom duration. For symptom duration of less than 1week, technical success was 85.4% (181/212) versus 69.6% (39/56) for those with symptoms of greater than a week (p<0.05). Clinical success rates fell from 71.3% (107/150) to 59.3% (70/118) (p<0.05) when attempting to stent lesions of greater than 5cm. There was also a significant reduction in clinical success when stenting lesions on a bend rather than a straight segment of colon 75.7% (109/144) versus 59.7% (74/124) (p<0.05). A total of 20 (7.46%) perforations were identified during the study. Stent migration occurred in 6.6% of cases. In-stent stenosis occurred in 3.3%. The overall 30-day all cause mortality rate was 9%. Lesion size, location and duration of obstructive symptoms are statistically significant determinants of patient outcome. These factors could be used to advise patient selection for colonic stenting or direct progression to surgical intervention.
Published Version
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