scholarly journals Colorectal Stenting in Malignant Large Bowel Obstruction: The Learning Curve

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
D. Williams ◽  
R. Law ◽  
A. M. Pullyblank
Keyword(s):  
Colorectal Cancer ◽  
Learning Curve ◽  
Bowel Obstruction ◽  
Case Series ◽  
Large Bowel Obstruction ◽  
Metal Stents ◽  
Bridge To Surgery ◽  
Success Rates ◽  
Colorectal Stenting ◽  
Colorectal Cancer Patients

Aim. Self-expanding metal stents (SEMSs) are increasingly used for the palliation of metastatic colorectal cancer and as a bridge to surgery for obstructing tumours. This case series analyses the learning curve and changes in practice of colorectal stenting over a three year period.Methods. A study of 40 patients who underwent placement of SEMS for the management of colorectal cancer. Patients spanned the learning curve of a single surgeon endoscopist.Results. Technical success rates increased from 82% initially, using an average of 1.7 stents per procedure, to a 94% success rate where all patients were stented using a single stent. There has been a change in practice from elective palliative stenting toward emergency preoperative stenting.Conclusion. There is a steep learning curve for the use of SEMS in the management of malignant colorectal bowel obstruction. We suggest that at least 20 cases are required for an operator to be considered experienced.

Tu1689 - Long-Term Outcomes of Colorectal Cancer Patients with and without Malignant Large-Bowel Obstruction

2018 ◽  
Vol 154 (6) ◽  
pp. S-1352
Author(s):  
Riku Yamamoto ◽  
Shinya Munakata ◽  
Tomoyuki Kushida ◽  
Hajime Orita ◽  
Mutsumi Sakurada ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Bowel Obstruction ◽  
Large Bowel ◽  
Large Bowel Obstruction ◽  
Long Term Outcomes ◽  
Colorectal Cancer Patients

scholarly journals Long-term outcomes of colorectal cancer patients with and without malignant large-bowel obstruction

2018 ◽  
Vol 7 (2) ◽  
pp. CRC04
Author(s):  
Shinya Munakata ◽  
Yuta Murai ◽  
Akihiro Koiuzumi ◽  
Hisaki Kato ◽  
Riku Yamamoto ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Bowel Obstruction ◽  
Large Bowel ◽  
Large Bowel Obstruction ◽  
Long Term Outcomes ◽  
Colorectal Cancer Patients

scholarly journals “Stent in Stent” Procedure for Treatment of Extreme Strictures of Colorectal Cancer – Case Series in a Single Center: How to Do it

2020 ◽  
pp. 1-5
Author(s):  
Giungato Simone ◽  
Giungato Simone ◽  
Giordano G ◽  
Fazzolari L ◽  
Putignano C ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Bowel Obstruction ◽  
Large Bowel ◽  
Case Series ◽  
Large Bowel Obstruction ◽  
Technical Note ◽  
Cancer Case ◽  
Metal Stent ◽  
Synchronous Colorectal Cancer ◽  
Colorectal Cancer Case

Background: Since 1990’s the use of self-expanding metal stent has been known. Initially, this kind of technique has been debated in literature. Actually, is a widely used technique for treatment of bowel neoplastic obstruction. This procedure is important to restore bowel canalization but is feasible performed by expert endoscopists and a dedicated anesthesiologist team. More difficult seems to be the treatment of strictures longer than 9 cm of large bowel or synchronous very close stenosis of rectal-sigmoid junction and rectum. This technical note demonstrated how SEMS positioning can be performed for treatment of long and extreme large bowel obstruction. Methods: In this case series we have treated all patients admitted in our department with diagnosis of extreme bowel neoplastic obstruction, with “stent in stent” technique, in deep sedation. Results: From January to August 2019 we admitted in our Surgical and Endoscopic Unit two patients, a 90- year-old for bowel obstruction by synchronous colorectal cancer and a 80-year-old female for 15 cm large bowel neoplastic obstruction. Patients were submitted to “Stent-in-Stent” technique. No complications and perforation were observed with restore of bowel canalization after few hours from SEMS positioning. Both patients had no signs of bowel obstruction at abdomen X-Ray control, after 48 hours. 80-year-old female patient was submitted to left colectomy after 6 days without complications, while 90-year-old was discharge after 3 days. Conclusion: This study demonstrated how is possible to perform endoscopic SEMS positioning to treat longer than 15 cm neoplastic large bowel obstruction and synchronous colorectal cancer with “Stent-inStent” technique. Our technical note describes, point by point, all passages of this procedure and suggests as is possible to treat synchronous sigmoid-rectal neoplastic obstruction using two different kind of metal stent.

scholarly journals Bowel Obstruction and Perforation as Emergency Presenting Sign of Colorectal Cancer with Peritoneal Carcinomatosis: A Case Report and Review

2020 ◽  
Vol 21 (3) ◽  
pp. 235-240
Author(s):  
Randy Adiwinata ◽  
Linda Rotty ◽  
Michael Tendean ◽  
Bradley Jimmy Waleleng ◽  
Fandy Gosal ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Peritoneal Carcinomatosis ◽  
Bowel Obstruction ◽  
Large Bowel ◽  
Bowel Perforation ◽  
Colorectal Cancer Patient ◽  
Large Bowel Obstruction ◽  
Emergency Laparotomy ◽  
History Of ◽  
Colorectal Cancer Patients

Colorectal cancer patient may present with variable clinical presentation. In few cases, colorectal cancer may present as emergency such as uncontrollable gastrointestinal bleeding, large bowel obstruction and in rarer fashion is bowel perforation. Worse prognosis is linked with emergency presenting colorectal cancer. Peritoneal carcinomatosis may occur in 10-35% of colorectal cancer patients and may develop bowel obstruction along with the primary colorectal cancer. Here, we report a-62-year-old man presented with large bowel obstruction leading to perforation without known history of colorectal cancer before. On emergency laparotomy, we found colorectal cancer and peritoneal carcinomatosis as the underlying cause. Prompt diagnosis and urgent management is warranted to improve the prognosis.

Short-term results of self-expanding metal stents for acute malignant large bowel obstruction

2017 ◽  
Vol 19 (10) ◽  
pp. O365-O371 ◽  
Author(s):  
M. Kobborg ◽  
M. Broholm ◽  
E. Frostberg ◽  
M. Jeppesen ◽  
I. Gögenür
Keyword(s):  
Bowel Obstruction ◽  
Large Bowel ◽  
Large Bowel Obstruction ◽  
Metal Stents ◽  
Short Term ◽  
Self Expanding Metal Stents

scholarly journals Examination of Physicians’ Perception of the Indications of Colorectal Stents in the Management of Malignant Large Bowel Obstruction: A Provincial Survey

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Jean-Frédéric LeBlanc ◽  
Myriam Martel ◽  
Alan N. Barkun
Keyword(s):  
Bowel Obstruction ◽  
Large Bowel ◽  
Young Patients ◽  
Large Bowel Obstruction ◽  
Sems Placement ◽  
Adherence To Guidelines ◽  
Web Based ◽  
Clinical Scenarios ◽  
Colorectal Stenting ◽  
Expandable Metallic Stents

Introduction. Data are conflicting when assessing indications for colorectal self-expandable metallic stents (SEMS) in managing acute malignant large bowel obstruction (MLO). In November 2014, European and American Societies published guidelines to aid in understanding which patients might benefit from colorectal stenting. Yet, there remain marked disparities in clinical practice.Methods. A web-based survey was sent to Gastroenterologists and Surgical Specialists across Quebec to assess physicians’ knowledge and adherence to the indications for colonic SEMS placement in the management of MLO using eight clinical scenarios.Results. Out of 112 respondents, 74% preferred surgical intervention in young, healthy individuals with MLO. Advanced age and comorbidities motivated 56.3% (95% CI 47.1–65.5%) of participants to opt for SEMS placement. In palliative settings of patients undergoing chemotherapy including bevacizumab, a minority of respondents followed guidelines, 12.5% (95% CI 6.4–18.6%) for young patients and 25.0% for elderly patients (95% CI 17.0–33.0%). The pooled overall adherence to guidelines was 50.4% (95% CI 40.7–59.3%).Conclusion. This survey suggests that guidelines recommendations are not being implemented by at least half of specialists involved in the care of patients with MLO. Future studies should attempt to identify possible barriers responsible for this impaired knowledge translation and tailored educational initiatives planned accordingly.

scholarly journals P-060 Endoscopic colorectal stenting for malignant large bowel obstruction comparing to surgery

2016 ◽  
Vol 27 ◽  
pp. ii18
Author(s):  
D.H. Kang ◽  
H.W. Kim ◽  
C.W. Choi ◽  
S.B. Park ◽  
S.J. Kim ◽  
...  
Keyword(s):  
Bowel Obstruction ◽  
Large Bowel ◽  
Large Bowel Obstruction ◽  
Colorectal Stenting

scholarly journals Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yang Hu ◽  
Jiajun Fan ◽  
Yifan Xv ◽  
Yingjie Hu ◽  
Yuan Ding ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Emergency Surgery ◽  
Meta Analysis ◽  
Metal Stents ◽  
Bridge To Surgery ◽  
Sems Group ◽  
Obstructive Colorectal Cancer ◽  
Significant Difference ◽  
Self Expanding Metal Stents

Abstract Background To explore the long-term oncological safety of using self-expanding metal stents (SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery (ES) with elective surgery after the placement of SEMS. Methods Studies comparing SEMS as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated for the outcomes under random effects model. Results A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence of perineural invasion (RR = 0.58, 95% CI 0.48, 0.71, P < 0.00001), lymphovascular invasion (RR = 0.68, 95% CI 0.47, 0.99, P = 0.004) and vascular invasion (RR = 0.66, 95% CI 0.45, 0.99, P = 0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion (RR = 0.92, 95% CI 0.77, 1.09, P = 0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group (MD = − 3.18, 95% CI − 4.47, − 1.90, P < 0.00001). While no significant difference was found in the number of positive lymph nodes (MD = − 0.11, 95% CI − 0.63, 0.42, P = 0.69) and N stage [N0 (RR = 1.03, 95% CI 0.92, 1.15, P = 0.60), N1 (RR = 0.99, 95% CI 0.87, 1.14, P = 0.91), N2 (RR = 0.94, 95% CI 0.77, 1.15, P = 0.53)]. Conclusions SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, their adverse effects cannot be ignored. The use of SEMS as the preferred treatment for patients with resectable obstructive colorectal cancer remains to be carefully weighed, especially when patients are young or the surgical risk is not very high.

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