Self-expanding metal stent insertion by colorectal surgeons using a two-person approach colonoscopy without fluoroscopic monitoring in the management of acute colorectal obstruction: a 14-year experience

World Journal of Surgical Oncology

E. Ji-fu¹  En-da Yu¹  Zhen Wang¹  Bing-chen Chen¹  Fei-hu Yan²  Yao Zhang³  Hao Wang⁴  Xiao-shuang Liu⁵  Cheng-ling Bian⁶ 

[1] Department of Colorectal Surgery, Changhai Hospital, Naval Military Medical University, 200433, Shanghai, China;Department of Colorectal Surgery, Changhai Hospital, Naval Military Medical University, 200433, Shanghai, China;Department of Medical Statistics Faculty of Medical Services, PLA Navy Medical University, 200433, Shanghai, China;Department of Gastroenterology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, 200025, Shanghai, China;Department of General Surgery, Eastern Theater Naval Hospital, 316000, Zhoushan, China;Department of General Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 201203, Shanghai, China;Department of Radiology, Changhai Hospital, Naval Military Medical University, 200433, Shanghai, China;

关键词: Colorectal stenting;    No fluoroscopy guiding;    Large bowel obstruction;    Colorectal cancer;    Extra-luminal compression;    Benign colorectal diseases;    Recurrent tumor;    Learning curve;   

DOI  :  10.1186/s12957-021-02309-z

来源: Springer

【 摘 要 】

BackgroundPlacement of a self-expanding metal stent (SEMS) in patients presenting with an acute colorectal obstruction (ACO) may obviate emergency surgery (ES), potentially effectively palliating incurable tumors, acting as a bridge to surgery (BTS) in patients with operable or potentially operable tumors and achieving effective decompression of other ACO. We present our experience with SEMS insertion by colorectal surgeons without fluoroscopic monitoring for ACO especially for acute malignant colorectal obstruction (AMCO) for nearly a 14-year period (2007–2020).AimTo explore the safety and effectiveness of SEMS insertion in the management of ACO by colorectal surgeons using a two-person approach colonoscopy without fluoroscopic monitoring.MethodsWe reviewed the medical records of patients retrospectively to identify all patients presenting to our unit with ACO especially with AMCO who had stenting carried out to achieve colonic decompression. All 434 procedures were performed by colorectal surgeons using a two-person approach colonoscopy without fluoroscopic monitoring.ResultsThe overall technique success rate and clinic success rate by SEMS insertion were 428/434 (98.6%) and 412/434 (94.9%). The overall incidence of complications by SEMS insertion was 19/434 (4.4%). The complications included clinical perforation (6/434, 1.4%); stent migration (2/434, 0.5%), 1 of which re-stent; stent detachment (fell off) (3/434, 0.7%), none of them with re-stent; stool impaction (6/434, 1.4%), 1 of which re-stent; and abdominal or anal pain (2/434, 0.5%). There was no hemorrhage in any of the 434 patients.ConclusionsSEMS insertion is a relatively safe and effective technique for colonic decompression in dealing with ACO as either a BTS or as a palliative measure. It is also a solution to other causes of ACO such as recurrent tumor, benign diseases, or extra-luminal compression. Therefore, ES was largely avoided.

【 授权许可】

CC BY