Colonic stenting in acute malignant large bowel obstruction: audit of efficacy and safety in a Singapore tertiary referral centre
Introduction: Acute malignant large bowel obstruction (MBO) occurs in 8%–15% of colorectal cancer patients. Self-expandable metal stents (SEMS) have progressed from a palliative modality to use as bridge to surgery (BTS). We aimed to assess the safety and efficacy of SEMS for MBO in our institution....
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| Format: | Article |
| Language: | English |
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Wolters Kluwer – Medknow Publications
2023-10-01
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| Series: | Singapore Medical Journal |
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| Online Access: | https://journals.lww.com/10.11622/smedj.2021127 |
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| _version_ | 1823861395769262080 |
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| author | James Weiquan Li James Chi-Yong Ngu Kok Ren Lim Shu Wen Tay Bochao Jiang Ramesh Wijaya Sulaiman Yusof Calvin Jianming Ong Andrew Boon Eu Kwek Tiing Leong Ang |
| author_facet | James Weiquan Li James Chi-Yong Ngu Kok Ren Lim Shu Wen Tay Bochao Jiang Ramesh Wijaya Sulaiman Yusof Calvin Jianming Ong Andrew Boon Eu Kwek Tiing Leong Ang |
| author_sort | James Weiquan Li |
| collection | DOAJ |
| description | Introduction:
Acute malignant large bowel obstruction (MBO) occurs in 8%–15% of colorectal cancer patients. Self-expandable metal stents (SEMS) have progressed from a palliative modality to use as bridge to surgery (BTS). We aimed to assess the safety and efficacy of SEMS for MBO in our institution.
Methods:
The data of patients undergoing SEMS insertion for MBO were reviewed. Technical success was defined as successful SEMS deployment across tumour without complications. Clinical success was defined as colonic decompression without requiring further surgical intervention. Rates of complications, median time to surgery, types of surgery and rates of recurrence were studied.
Results:
Seventy-nine patients underwent emergent SEMS placement from September 2013 to February 2020. Their mean age was 68.8 ± 13.8 years and 43 (54%) patients were male. Mean tumour length was 4.2 cm ± 2.2 cm; 89.9% of malignant strictures were located distal to the splenic flexure. Technical and clinical success was 94.9% and 98.7%, respectively. Perforation occurred in 5.1% of patients, with none having stent migration or bleeding. Fifty (63.3%) patients underwent SEMS insertion as BTS. Median time to surgery was 20 (range 6–57) days. Most (82%) patients underwent minimally invasive surgery. Primary anastomosis rate was 98%. Thirty-nine patients had follow-up beyond 1-year posttreatment (median 34 months). Local recurrence and distant metastasis were observed in 4 (10.3%) and 5 (12.8%) patients, respectively.
Conclusion:
Insertion of SEMS for acute MBO has high success rates and a good safety profile. Most patients in this audit underwent minimally invasive surgery and primary anastomosis after successful BTS. |
| format | Article |
| id | doaj-art-18b5d47b83c94d60badb29ea704c8853 |
| institution | Kabale University |
| issn | 0037-5675 2737-5935 |
| language | English |
| publishDate | 2023-10-01 |
| publisher | Wolters Kluwer – Medknow Publications |
| record_format | Article |
| series | Singapore Medical Journal |
| spelling | doaj-art-18b5d47b83c94d60badb29ea704c88532025-02-09T14:05:30ZengWolters Kluwer – Medknow PublicationsSingapore Medical Journal0037-56752737-59352023-10-01641060360810.11622/smedj.2021127Colonic stenting in acute malignant large bowel obstruction: audit of efficacy and safety in a Singapore tertiary referral centreJames Weiquan LiJames Chi-Yong NguKok Ren LimShu Wen TayBochao JiangRamesh WijayaSulaiman YusofCalvin Jianming OngAndrew Boon Eu KwekTiing Leong AngIntroduction: Acute malignant large bowel obstruction (MBO) occurs in 8%–15% of colorectal cancer patients. Self-expandable metal stents (SEMS) have progressed from a palliative modality to use as bridge to surgery (BTS). We aimed to assess the safety and efficacy of SEMS for MBO in our institution. Methods: The data of patients undergoing SEMS insertion for MBO were reviewed. Technical success was defined as successful SEMS deployment across tumour without complications. Clinical success was defined as colonic decompression without requiring further surgical intervention. Rates of complications, median time to surgery, types of surgery and rates of recurrence were studied. Results: Seventy-nine patients underwent emergent SEMS placement from September 2013 to February 2020. Their mean age was 68.8 ± 13.8 years and 43 (54%) patients were male. Mean tumour length was 4.2 cm ± 2.2 cm; 89.9% of malignant strictures were located distal to the splenic flexure. Technical and clinical success was 94.9% and 98.7%, respectively. Perforation occurred in 5.1% of patients, with none having stent migration or bleeding. Fifty (63.3%) patients underwent SEMS insertion as BTS. Median time to surgery was 20 (range 6–57) days. Most (82%) patients underwent minimally invasive surgery. Primary anastomosis rate was 98%. Thirty-nine patients had follow-up beyond 1-year posttreatment (median 34 months). Local recurrence and distant metastasis were observed in 4 (10.3%) and 5 (12.8%) patients, respectively. Conclusion: Insertion of SEMS for acute MBO has high success rates and a good safety profile. Most patients in this audit underwent minimally invasive surgery and primary anastomosis after successful BTS.https://journals.lww.com/10.11622/smedj.2021127acute malignant bowel obstructionbridge to surgerycolonic stentingcolorectal cancersems |
| spellingShingle | James Weiquan Li James Chi-Yong Ngu Kok Ren Lim Shu Wen Tay Bochao Jiang Ramesh Wijaya Sulaiman Yusof Calvin Jianming Ong Andrew Boon Eu Kwek Tiing Leong Ang Colonic stenting in acute malignant large bowel obstruction: audit of efficacy and safety in a Singapore tertiary referral centre Singapore Medical Journal acute malignant bowel obstruction bridge to surgery colonic stenting colorectal cancer sems |
| title | Colonic stenting in acute malignant large bowel obstruction: audit of efficacy and safety in a Singapore tertiary referral centre |
| title_full | Colonic stenting in acute malignant large bowel obstruction: audit of efficacy and safety in a Singapore tertiary referral centre |
| title_fullStr | Colonic stenting in acute malignant large bowel obstruction: audit of efficacy and safety in a Singapore tertiary referral centre |
| title_full_unstemmed | Colonic stenting in acute malignant large bowel obstruction: audit of efficacy and safety in a Singapore tertiary referral centre |
| title_short | Colonic stenting in acute malignant large bowel obstruction: audit of efficacy and safety in a Singapore tertiary referral centre |
| title_sort | colonic stenting in acute malignant large bowel obstruction audit of efficacy and safety in a singapore tertiary referral centre |
| topic | acute malignant bowel obstruction bridge to surgery colonic stenting colorectal cancer sems |
| url | https://journals.lww.com/10.11622/smedj.2021127 |
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