Retrospective Study
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World J Gastroenterol. May 28, 2014; 20(20): 6309-6313
Published online May 28, 2014. doi: 10.3748/wjg.v20.i20.6309
Outcomes after stenting for malignant large bowel obstruction without radiologist support
Rao Khalid Mehmood, Jody Parker, Patricia Kirkbride, Shakil Ahmed, Fayyaz Akbar, Eays Qasem, Muhammad Zeeshan, Ernest Jehangir
Rao Khalid Mehmood, Jody Parker, Fayyaz Akbar, Eays Qasem, Department of Surgery, Betsi Cadwaladr University Health Board, Rhyl, North Wales LL18 5UJ, United Kingdom
Patricia Kirkbride, Muhammad Zeeshan, Ernest Jehangir, North Cumbria University Hospitals NHS Trusts, West Cumberland Hospital, Whitehaven CA28 8JX, United Kingdom
Shakil Ahmed, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool L7 8XP, United Kingdom
Author contributions: Mehmood RK designed the proforma for data collection, analysed the data, wrote the abstract and collected relevant articles; Parker J analysed the data, wrote and revised the article and collected relevant articles; Kirkbride P collected the data; Ahmed S and Zeeshan M editing the manuscript; Akbar F and Qasem E coordinated the collection of relevant articles; Jehangir E performed the procedures and supervised the article.
Correspondence to: Rao Khalid Mehmood, Consultant Surgeon, Department of Surgery, Betsi Cadwaladr University Health Board, Ysbyty Glan Clwyd, Rhyl, Denbighshire LL18 5UJ, United Kingdom.
Telephone: +44-1745-583910 Fax: +44-1745-534688
Received: October 7, 2013
Revised: February 23, 2014
Accepted: March 19, 2014
Published online: May 28, 2014

AIM: To assess outcomes after colonic stent insertion for obstructing colorectal malignancies performed by an endoscopist without radiologist support.

METHODS: This is a retrospective study of all stents inserted by a single surgeon in a District General Hospital over an eight year period. All stents were inserted for patients with acute large bowel obstruction secondary to a malignant colorectal pathology either for palliation or as a bridge to surgery. Procedures were performed by a single surgeon endoscopically with fluoroscopic control in the X-ray department but without the support of an interventional radiologist. Data was collected prospectively on a pre-designed database.

RESULTS: The indication for all stent procedures was an obstructing colorectal malignancy. Out of 53 patients, the overall success rate was 90.6%. Eight patients had a stent intended as a bridge to surgery and 45 as a palliative procedure. Technical success was achieved in 50 out of 53 procedures (94.3%) and clinical success in 48 of those remaining 50 (96.0%). Those with unsuccessful technical or clinical procedures went on to have defunctioning stomas to treat their obstruction. There were six complications from the technically successful stents (12.0%). These included one migration, one persisting obstructive symptoms and four cases of tumour overgrowth of the stents at a later date. Haemorrhagic complications, perforation or mortality were not observed in our series. Our results are comparable to several other studies assessing stent outcomes for obstructing bowel cancer.

CONCLUSION: Our data suggests that colorectal stents can be inserted without radiologist support by an adequately trained individual with good outcomes.

Keywords: Self-expanding colonic stents, Colorectal cancer, Palliation, Interventional radiology, Endoscopy

Core tip: There is now a good amount of evidence showing that colonic stents are a safe management option for obstruction secondary to colonic malignancy despite other safety concerns in the literature. Despite guideline recommendations that they should be performed as a joint procedure with both an endoscopist and radiologist, limitations of everyday practice may restrict this. Our data shows that procedures can be performed just as safely by only an endoscopist with good success rates and few complications. This may help improve availability of such procedures and reduced financial costs.