Management of large bowel obstruction with self-expanding metal stents. A multicentre retrospective study of factors determining outcome
Aim UK cancer guidelines recommend patients with colonic obstruction due to suspected malignancy be considered for stenting with a self‐expanding metal stent (SEMS). Considerable variation in practice exists due to a lack of expertise, technical difficulties and other, as yet ill‐defined features. T...
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| Veröffentlicht in: | Colorectal disease 2014-06, Vol.16 (6), p.476-483 |
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| creator | Geraghty, J. Sarkar, S. Cox, T. Lal, S. Willert, R. Ramesh, J. Bodger, K. Carlson, G. L. |
| description | Aim
UK cancer guidelines recommend patients with colonic obstruction due to suspected malignancy be considered for stenting with a self‐expanding metal stent (SEMS). Considerable variation in practice exists due to a lack of expertise, technical difficulties and other, as yet ill‐defined features. This retrospective multi‐centre study aims to determine the outcome following colonic stenting for large bowel obstruction and identify factors associated with successful intervention.
Method
A regional programme of colonic stenting for large bowel obstruction, in five UK centres from 2005 to 2010 was evaluated for outcome including technical and clinical success, survival, complications and reoperation.
Results
A SEMS was inserted in 334 patients, including 264 (79.0%) for palliation and 52 (15.6%) as a bridge to surgery. Technical success was achieved in 292 (87.4%) patients, with 46 (13.8%) experiencing a complication or technical failure. Reoperation was required in 39 (14.8%) patients stented for palliation of colorectal cancer of whom 16 (6.1%) subsequently required a colostomy. A one‐stage primary anastomosis was achieved in 35 (67.3%) of the 52 patients undergoing stenting as a bridge to resection. Technical success did not vary by indication or site of obstruction (P = 0.60) but was higher for operators who had performed more than 10 procedures (OR 3.34, P = 0.001). ASA grade ≥3 predicted a worse clinical outcome (OR 0.43, P = 0.04). The through‐the‐scope (TTS) endoscopy technique was more successful than radiological placement alone (90.3% vs 74.8%, P |
| doi_str_mv | 10.1111/codi.12582 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1526129697</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1526129697</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3672-85dadc45e7934dc1e14499efaa34aebde50bc7cb471644ced8cd77981c3c38e3</originalsourceid><addsrcrecordid>eNp9kMFu1DAQhq0K1JbChQdAPiKkLJnYiZNj2Za20kIvlThajj1ZDE682A7bfYM-Nt5u2yNz8Vj6_k-an5D3UC4gz2ftjV1AVbfVETkF3rACGLSvHveqaDsoT8ibGH-VJTQC2mNyUvG6bIBXp-Thm5rUGkecEvUDdSqskfZ-i476PqYw62T9RLc2_aQR3VDg_UZNxk5rOmJSjsaUo3FBz-k4u2R1_gWkAVPwcYM5_RczM5vdXj8onXyI1GDCMNppr_Fz0n7Et-T1oFzEd0_vGbn7enm3vC5Wt1c3y_NVoVkj8jW1UUbzGkXHuNGAwHnX4aAU4wp7g3XZa6F7LqDhXKNptRGia0EzzVpkZ-TjQbsJ_s-MMcnRRo3OqQn9HCXUVQNV13Qio58OqM6nxICD3AQ7qrCTUMp98XJfvHwsPsMfnrxzP6J5QZ-bzgAcgK11uPuPSi5vL26epcUhY3PL9y8ZFX7LRjBRyx_fr-QXBrAqL64lY_8Ajrqg4A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1526129697</pqid></control><display><type>article</type><title>Management of large bowel obstruction with self-expanding metal stents. A multicentre retrospective study of factors determining outcome</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>Geraghty, J. ; Sarkar, S. ; Cox, T. ; Lal, S. ; Willert, R. ; Ramesh, J. ; Bodger, K. ; Carlson, G. L.</creator><creatorcontrib>Geraghty, J. ; Sarkar, S. ; Cox, T. ; Lal, S. ; Willert, R. ; Ramesh, J. ; Bodger, K. ; Carlson, G. L.</creatorcontrib><description>Aim
UK cancer guidelines recommend patients with colonic obstruction due to suspected malignancy be considered for stenting with a self‐expanding metal stent (SEMS). Considerable variation in practice exists due to a lack of expertise, technical difficulties and other, as yet ill‐defined features. This retrospective multi‐centre study aims to determine the outcome following colonic stenting for large bowel obstruction and identify factors associated with successful intervention.
Method
A regional programme of colonic stenting for large bowel obstruction, in five UK centres from 2005 to 2010 was evaluated for outcome including technical and clinical success, survival, complications and reoperation.
Results
A SEMS was inserted in 334 patients, including 264 (79.0%) for palliation and 52 (15.6%) as a bridge to surgery. Technical success was achieved in 292 (87.4%) patients, with 46 (13.8%) experiencing a complication or technical failure. Reoperation was required in 39 (14.8%) patients stented for palliation of colorectal cancer of whom 16 (6.1%) subsequently required a colostomy. A one‐stage primary anastomosis was achieved in 35 (67.3%) of the 52 patients undergoing stenting as a bridge to resection. Technical success did not vary by indication or site of obstruction (P = 0.60) but was higher for operators who had performed more than 10 procedures (OR 3.34, P = 0.001). ASA grade ≥3 predicted a worse clinical outcome (OR 0.43, P = 0.04). The through‐the‐scope (TTS) endoscopy technique was more successful than radiological placement alone (90.3% vs 74.8%, P < 0.001).
Conclusion
Experienced operators using a TTS technique achieved a better outcome for the emergency management of large bowel obstruction. Older, sicker patients and those with extracolonic and benign strictures fared less well.</description><identifier>ISSN: 1462-8910</identifier><identifier>EISSN: 1463-1318</identifier><identifier>DOI: 10.1111/codi.12582</identifier><identifier>PMID: 24506142</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; Aged ; Colon - surgery ; Colonic Diseases - diagnosis ; Colonic Diseases - etiology ; Colonic Diseases - surgery ; Colonic Neoplasms - complications ; Colonic Neoplasms - mortality ; Colonoscopy - methods ; Colorectal cancer ; Disease Management ; Female ; Follow-Up Studies ; Humans ; Intestinal Obstruction - diagnosis ; Intestinal Obstruction - etiology ; Intestinal Obstruction - surgery ; large bowel obstruction ; Male ; Middle Aged ; Prosthesis Design ; Retrospective Studies ; SEMS ; Stents ; Survival Rate - trends ; Treatment Outcome ; United Kingdom - epidemiology</subject><ispartof>Colorectal disease, 2014-06, Vol.16 (6), p.476-483</ispartof><rights>Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland</rights><rights>Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3672-85dadc45e7934dc1e14499efaa34aebde50bc7cb471644ced8cd77981c3c38e3</citedby><cites>FETCH-LOGICAL-c3672-85dadc45e7934dc1e14499efaa34aebde50bc7cb471644ced8cd77981c3c38e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fcodi.12582$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fcodi.12582$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24506142$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Geraghty, J.</creatorcontrib><creatorcontrib>Sarkar, S.</creatorcontrib><creatorcontrib>Cox, T.</creatorcontrib><creatorcontrib>Lal, S.</creatorcontrib><creatorcontrib>Willert, R.</creatorcontrib><creatorcontrib>Ramesh, J.</creatorcontrib><creatorcontrib>Bodger, K.</creatorcontrib><creatorcontrib>Carlson, G. L.</creatorcontrib><title>Management of large bowel obstruction with self-expanding metal stents. A multicentre retrospective study of factors determining outcome</title><title>Colorectal disease</title><addtitle>Colorectal Dis</addtitle><description>Aim
UK cancer guidelines recommend patients with colonic obstruction due to suspected malignancy be considered for stenting with a self‐expanding metal stent (SEMS). Considerable variation in practice exists due to a lack of expertise, technical difficulties and other, as yet ill‐defined features. This retrospective multi‐centre study aims to determine the outcome following colonic stenting for large bowel obstruction and identify factors associated with successful intervention.
Method
A regional programme of colonic stenting for large bowel obstruction, in five UK centres from 2005 to 2010 was evaluated for outcome including technical and clinical success, survival, complications and reoperation.
Results
A SEMS was inserted in 334 patients, including 264 (79.0%) for palliation and 52 (15.6%) as a bridge to surgery. Technical success was achieved in 292 (87.4%) patients, with 46 (13.8%) experiencing a complication or technical failure. Reoperation was required in 39 (14.8%) patients stented for palliation of colorectal cancer of whom 16 (6.1%) subsequently required a colostomy. A one‐stage primary anastomosis was achieved in 35 (67.3%) of the 52 patients undergoing stenting as a bridge to resection. Technical success did not vary by indication or site of obstruction (P = 0.60) but was higher for operators who had performed more than 10 procedures (OR 3.34, P = 0.001). ASA grade ≥3 predicted a worse clinical outcome (OR 0.43, P = 0.04). The through‐the‐scope (TTS) endoscopy technique was more successful than radiological placement alone (90.3% vs 74.8%, P < 0.001).
Conclusion
Experienced operators using a TTS technique achieved a better outcome for the emergency management of large bowel obstruction. Older, sicker patients and those with extracolonic and benign strictures fared less well.</description><subject>Adult</subject><subject>Aged</subject><subject>Colon - surgery</subject><subject>Colonic Diseases - diagnosis</subject><subject>Colonic Diseases - etiology</subject><subject>Colonic Diseases - surgery</subject><subject>Colonic Neoplasms - complications</subject><subject>Colonic Neoplasms - mortality</subject><subject>Colonoscopy - methods</subject><subject>Colorectal cancer</subject><subject>Disease Management</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Intestinal Obstruction - diagnosis</subject><subject>Intestinal Obstruction - etiology</subject><subject>Intestinal Obstruction - surgery</subject><subject>large bowel obstruction</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prosthesis Design</subject><subject>Retrospective Studies</subject><subject>SEMS</subject><subject>Stents</subject><subject>Survival Rate - trends</subject><subject>Treatment Outcome</subject><subject>United Kingdom - epidemiology</subject><issn>1462-8910</issn><issn>1463-1318</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMFu1DAQhq0K1JbChQdAPiKkLJnYiZNj2Za20kIvlThajj1ZDE682A7bfYM-Nt5u2yNz8Vj6_k-an5D3UC4gz2ftjV1AVbfVETkF3rACGLSvHveqaDsoT8ibGH-VJTQC2mNyUvG6bIBXp-Thm5rUGkecEvUDdSqskfZ-i476PqYw62T9RLc2_aQR3VDg_UZNxk5rOmJSjsaUo3FBz-k4u2R1_gWkAVPwcYM5_RczM5vdXj8onXyI1GDCMNppr_Fz0n7Et-T1oFzEd0_vGbn7enm3vC5Wt1c3y_NVoVkj8jW1UUbzGkXHuNGAwHnX4aAU4wp7g3XZa6F7LqDhXKNptRGia0EzzVpkZ-TjQbsJ_s-MMcnRRo3OqQn9HCXUVQNV13Qio58OqM6nxICD3AQ7qrCTUMp98XJfvHwsPsMfnrxzP6J5QZ-bzgAcgK11uPuPSi5vL26epcUhY3PL9y8ZFX7LRjBRyx_fr-QXBrAqL64lY_8Ajrqg4A</recordid><startdate>201406</startdate><enddate>201406</enddate><creator>Geraghty, J.</creator><creator>Sarkar, S.</creator><creator>Cox, T.</creator><creator>Lal, S.</creator><creator>Willert, R.</creator><creator>Ramesh, J.</creator><creator>Bodger, K.</creator><creator>Carlson, G. L.</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201406</creationdate><title>Management of large bowel obstruction with self-expanding metal stents. A multicentre retrospective study of factors determining outcome</title><author>Geraghty, J. ; Sarkar, S. ; Cox, T. ; Lal, S. ; Willert, R. ; Ramesh, J. ; Bodger, K. ; Carlson, G. L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3672-85dadc45e7934dc1e14499efaa34aebde50bc7cb471644ced8cd77981c3c38e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Colon - surgery</topic><topic>Colonic Diseases - diagnosis</topic><topic>Colonic Diseases - etiology</topic><topic>Colonic Diseases - surgery</topic><topic>Colonic Neoplasms - complications</topic><topic>Colonic Neoplasms - mortality</topic><topic>Colonoscopy - methods</topic><topic>Colorectal cancer</topic><topic>Disease Management</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Intestinal Obstruction - diagnosis</topic><topic>Intestinal Obstruction - etiology</topic><topic>Intestinal Obstruction - surgery</topic><topic>large bowel obstruction</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prosthesis Design</topic><topic>Retrospective Studies</topic><topic>SEMS</topic><topic>Stents</topic><topic>Survival Rate - trends</topic><topic>Treatment Outcome</topic><topic>United Kingdom - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Geraghty, J.</creatorcontrib><creatorcontrib>Sarkar, S.</creatorcontrib><creatorcontrib>Cox, T.</creatorcontrib><creatorcontrib>Lal, S.</creatorcontrib><creatorcontrib>Willert, R.</creatorcontrib><creatorcontrib>Ramesh, J.</creatorcontrib><creatorcontrib>Bodger, K.</creatorcontrib><creatorcontrib>Carlson, G. L.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Geraghty, J.</au><au>Sarkar, S.</au><au>Cox, T.</au><au>Lal, S.</au><au>Willert, R.</au><au>Ramesh, J.</au><au>Bodger, K.</au><au>Carlson, G. L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management of large bowel obstruction with self-expanding metal stents. A multicentre retrospective study of factors determining outcome</atitle><jtitle>Colorectal disease</jtitle><addtitle>Colorectal Dis</addtitle><date>2014-06</date><risdate>2014</risdate><volume>16</volume><issue>6</issue><spage>476</spage><epage>483</epage><pages>476-483</pages><issn>1462-8910</issn><eissn>1463-1318</eissn><abstract>Aim
UK cancer guidelines recommend patients with colonic obstruction due to suspected malignancy be considered for stenting with a self‐expanding metal stent (SEMS). Considerable variation in practice exists due to a lack of expertise, technical difficulties and other, as yet ill‐defined features. This retrospective multi‐centre study aims to determine the outcome following colonic stenting for large bowel obstruction and identify factors associated with successful intervention.
Method
A regional programme of colonic stenting for large bowel obstruction, in five UK centres from 2005 to 2010 was evaluated for outcome including technical and clinical success, survival, complications and reoperation.
Results
A SEMS was inserted in 334 patients, including 264 (79.0%) for palliation and 52 (15.6%) as a bridge to surgery. Technical success was achieved in 292 (87.4%) patients, with 46 (13.8%) experiencing a complication or technical failure. Reoperation was required in 39 (14.8%) patients stented for palliation of colorectal cancer of whom 16 (6.1%) subsequently required a colostomy. A one‐stage primary anastomosis was achieved in 35 (67.3%) of the 52 patients undergoing stenting as a bridge to resection. Technical success did not vary by indication or site of obstruction (P = 0.60) but was higher for operators who had performed more than 10 procedures (OR 3.34, P = 0.001). ASA grade ≥3 predicted a worse clinical outcome (OR 0.43, P = 0.04). The through‐the‐scope (TTS) endoscopy technique was more successful than radiological placement alone (90.3% vs 74.8%, P < 0.001).
Conclusion
Experienced operators using a TTS technique achieved a better outcome for the emergency management of large bowel obstruction. Older, sicker patients and those with extracolonic and benign strictures fared less well.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>24506142</pmid><doi>10.1111/codi.12582</doi><tpages>8</tpages></addata></record> |
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| source | MEDLINE; Wiley Online Library All Journals |
| subjects | Adult Aged Colon - surgery Colonic Diseases - diagnosis Colonic Diseases - etiology Colonic Diseases - surgery Colonic Neoplasms - complications Colonic Neoplasms - mortality Colonoscopy - methods Colorectal cancer Disease Management Female Follow-Up Studies Humans Intestinal Obstruction - diagnosis Intestinal Obstruction - etiology Intestinal Obstruction - surgery large bowel obstruction Male Middle Aged Prosthesis Design Retrospective Studies SEMS Stents Survival Rate - trends Treatment Outcome United Kingdom - epidemiology |
| title | Management of large bowel obstruction with self-expanding metal stents. A multicentre retrospective study of factors determining outcome |
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