Impact of restenting for recurrent colonic obstruction due to tumour ingrowth. Issue 6 (13th January 2018)

• Record Type: Journal Article
• Authors: Clarke, L; Abbott, H; Sharma, P; Eglinton, T W; Frizelle, F A
• Is Part Of: BJS open. Volume 1:Issue 6(2017)
• Page Start: 202
• Page End: 206
• Publication Date: 2018-01-13
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs5.34
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract: Background: Endoscopic stenting is used to palliate malignant large bowel obstruction. A proportion of patients will develop recurrent obstruction due to tumour ingrowth and require reintervention. This study aimed to assess the outcome (clinical success and complication rates) of endoscopic reintervention compared with surgical intervention in patients with stent obstruction due to tumour ingrowth. Methods: This was an observational study using data from a database of patients who underwent palliative colonic stenting between January 1998 and March 2017 at Christchurch Public Hospital. Results: A total of 190 patients underwent colonic stent insertion, for palliation in 182 cases. Reintervention was performed in 55 (30·2 per cent). Thirty-one patients (17·0 per cent) developed obstruction within the stent at a median of 4·6 (i.q.r. 2·3–7·7) months after the procedure. Of these, 21 had endoscopic restenting and ten underwent surgery. Restenting had technical and clinical success rates of 100 per cent, and involved a significantly shorter length of stay compared with surgery (median 2 (i.q.r. 1–4) versus 11 (6–19) days respectively; P = 0·006). Seven of the 21 patients in the restented group underwent a third palliative intervention. The overall stoma rate in the restented group was significantly lower than that in the surgical group (4 of 21 versus 10 of 10; P < 0·001). There was no difference in complications or survival between the two groups. Conclusion: Among palliative patients who develop malignant stent obstruction, endoscopic restenting had a high chance of technical success. It resulted in a shorter hospital stay and lower stoma rate than those seen after surgery. Graphical Abstract: This is the first reported series comparing repeat endoscopic intervention to surgery in palliative patients with colonic stent obstruction. It demonstrates that endoscopic restenting is safe, has a high success rate and is associated with a significant reduction in stoma formation, and a shorter length of stay, compared to surgery. Feasible, safe and effective