PWE-054 Endoscopic interventions avert permanent end ostomy in high-risk for adverse outcome(HRAO) patients. (June 2019) - Singh, Prabh
Abstract : Introduction: Anastomotic stenosis, fistulas or leaks distal to the loop ostomy either require a complex redo pelvic surgery or a potential conversion to end ostomy, both of which are associated with significant morbidity or mortality. Our aim was to assess minimally invasive endoscopic approaches as primary or rescue intervention in high-risk for adverse outcome (HRAO) patients who were otherwise destined to a permanent end ostomy. Method: All ostomy patients with endoscopic stent placement between May 2012 and July 2018 were included. Relevant demographic and clinical data were abstracted from the electronic medical record. Data was presented using descriptive methods. Results: A total of 12 (mean age 47.9y; 70% male) HRAO patients underwent minimally invasive endoscopic interventions: Eight patients had stenosis (66%), 2 patients had leak/fistula and 2 patients had stenosis as well as a fistula. The ostomy was performed for IBD in 6 (50%) patients, colorectal carcinoma in two, diverticulitis in two, rectal prolapse in one and recurrent sigmoid volvulus in one patient. Majority of the patients had ileostomy except one with colostomy and another with Altemeier procedure. 42% patients were on steroids, 58.3% were on immunosuppressants and 25% patients were smokers. 50% of the procedures were rescue interventions after reversal. Axios stents were used in 66% and Viabil in 34%. Stent diameter ranged from –5 mm and length from –0 mm. Two patients required a rendezvous antegrade-retrograde procedure. Adjunct therapies such as endoscopic suturing, transanal drainage, biocompatible plugs or biodegradable plugs were used in 33.3% of patients. On follow up, 10 patients (83%) had durable endoscopic response without the need for further interventions but two required surgery including one with permanent end ostomy. Both failures were in the patients who had strictures complicated by fistulas. One patient acutely presented with stent obstruction. In four patients stents spontaneously migrated without residual symptoms and in five, stents were removed after symptom resolution. One patient still has stent in place 8 months after endoscopic stent placement. Conclusion: Minimally invasive endoscopic management in high-risk for adverse outcome (HRAO) patients who were otherwise destined to a permanent end ostomy is a safe & effective management option. A consideration should be given to endoscopic intervention as it has potential to avert redo surgery or permanent end ostomy.