C J Young1, M K L Suen, J Young, M J Solomon. 1. Department of Colorectal Surgery, Royal Prince Alfred Hospital, New South Wales, Australia. cyoungnsw@aol.com
Abstract
AIM: Large bowel obstruction (LBO) is a surgical emergency that requires urgent operative intervention and often a stoma. The introduction of a self-expanding metallic stent provides an alternative for this group of patients. The aim of this study was to assess prospectively the results in the first 100 consecutive patients with LBO undergoing attempted self-expanding metallic stent insertion at the Royal Prince Alfred Hospital, Sydney, Australia. METHOD: A prospective consecutive uncontrolled trial of 100 patients having an attempted self-expanding metallic stent insertion for LBO was performed after institutional ethical approval. RESULTS:The mean age was 63.9 years (range 16-95). Primary colorectal cancer was the most common cause of LBO (61%). A self-expanding metallic stent was inserted with a palliative intent in 89% of patients. An initial technical success rate of 87% was achieved. Overall 30-day mortality was 7% (95% CI, 3.4-13.7%), with only one stent-related death within 30 days of stent insertion. Morbidity occurred in 20% of patients. Surgery was avoided in 69 patients and permanent stoma was avoided in 72 patients. The median follow up was 34.5 months (range 1-64 months). CONCLUSION: In this uncontrolled study, self-expanding metallic stents had a low morbidity and a low procedure-related mortality. A randomized controlled trial has commenced in our institution, in which length of stay, quality of life, morbidity and mortality of patients with stents are compared with those of patients having open procedures during palliative care for LBO.
RCT Entities:
AIM: Large bowel obstruction (LBO) is a surgical emergency that requires urgent operative intervention and often a stoma. The introduction of a self-expanding metallic stent provides an alternative for this group of patients. The aim of this study was to assess prospectively the results in the first 100 consecutive patients with LBO undergoing attempted self-expanding metallic stent insertion at the Royal Prince Alfred Hospital, Sydney, Australia. METHOD: A prospective consecutive uncontrolled trial of 100 patients having an attempted self-expanding metallic stent insertion for LBO was performed after institutional ethical approval. RESULTS: The mean age was 63.9 years (range 16-95). Primary colorectal cancer was the most common cause of LBO (61%). A self-expanding metallic stent was inserted with a palliative intent in 89% of patients. An initial technical success rate of 87% was achieved. Overall 30-day mortality was 7% (95% CI, 3.4-13.7%), with only one stent-related death within 30 days of stent insertion. Morbidity occurred in 20% of patients. Surgery was avoided in 69 patients and permanent stoma was avoided in 72 patients. The median follow up was 34.5 months (range 1-64 months). CONCLUSION: In this uncontrolled study, self-expanding metallic stents had a low morbidity and a low procedure-related mortality. A randomized controlled trial has commenced in our institution, in which length of stay, quality of life, morbidity and mortality of patients with stents are compared with those of patients having open procedures during palliative care for LBO.
Authors: Joyce V Veld; Kim J Beek; Esther C J Consten; Frank Ter Borg; Henderik L van Westreenen; Wilhelmus A Bemelman; Jeanin E van Hooft; Pieter J Tanis Journal: Colorectal Dis Date: 2021-01-15 Impact factor: 3.788