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1
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Horn A, Sabet M, Roghmann F, Meves V, Loss M, Hochberger J, Benckert C, Berger AW. Endoscopic trans-anal tube placement is a safe and helpful tool for colonic decompression: final results of a standardized single-centre retrospective assessment of 125 patients. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:175-182. [PMID: 36669527 DOI: 10.1055/a-1989-2062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Endoscopic trans-anal colonic decompression (ECD) may be requested in the case of massive colon distension, but evidence regarding success and safety issues remains scarce. The aim of this analysis is to examine the technical success, complications and clinical outcome in a large series of patients undergoing an ECD in various clinical scenarios. A standardized evaluation system was used to identify the pre-interventional risk parameters that might be helpful to guide clinical decision making. METHODS In this single-centre retrospective study, the modified Clavien-Dindo classification (CDC) was applied to assess technical success, complications and clinical outcome of 125 consecutive patients who underwent ECD between 2007 and 2020. PRIMARY ENDPOINT post interventional 90-day mortality. Secondary endpoints: periprocedural complications (CDC event IV-V) and technical success rate. All Martin criteria for standardized reporting of complications were met. Uni- and multivariable analyses for prediction of complications were carried out. RESULTS The overall technical success rate was 90%. The periprocedural complication rate was low with 3%. Overall 90-day mortality was 31%. Univariable analyses showed a significant correlation between 90-day mortality and ASA≥4 (p<0.001, odds ratio [OR] 15.33), general anaesthesia (p=0.05, OR 21.42) and elevated serological infection parameters (p 0.028, OR 1.004). The pre-interventional multivariable model identified ASA ≥4 (p <0.001; OR 10.94) as the only independent risk factor. CONCLUSIONS ECD is a safe, easily available, technical feasible, inexpensive and successful tool for colonic decompression in various colonic obstruction scenarios, even in critically ill patients. ASA Score ≥IV can be helpful to identify patients at risk for complications/mortality after ECD.
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Affiliation(s)
- Andreas Horn
- Praxis für Gastroenterologie, Berlin, Germany
- Department of Gastroenterology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Manij Sabet
- Department of General Surgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Florian Roghmann
- Department of Urology, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Volker Meves
- Department of Gastroenterology, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Martin Loss
- Department of General Surgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Juergen Hochberger
- Department of Gastroenterology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Christoph Benckert
- Department of General Surgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Andreas Wolfgang Berger
- Department of Gastroenterology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Department of internal medicine, Ulm University Medical Faculty, Ulm, Germany
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2
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Aboelezz AF, Othman MO. Endoscopic Management of Colonic Obstruction. Gastrointest Endosc Clin N Am 2024; 34:141-153. [PMID: 37973225 DOI: 10.1016/j.giec.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Large bowel obstruction is a serious event that occurs in approximately 25% of all intestinal obstructions. It is attributed to either benign, malignant, functional (pseudo-obstruction), or mechanical conditions. Benign etiologies of colonic obstructions include colon volvulus, anastomotic strictures, radiation injury, ischemia, inflammatory processes such as Crohn's disease, diverticulitis, bezoars, and intussusception.
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Affiliation(s)
- Ahmad F Aboelezz
- Department of Internal Medicine, Gastroenterology and Hepatology Section, Faculty of Medicine, Tanta University, El Bahr Street, Tanta Qism 2, Tanta 1, Gharbia Governorate 31111, Egypt
| | - Mohamed O Othman
- Department of Internal Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Gastroenterology Section at Baylor St Luke's Medical Center, 7200 Cambridge Street. Suite 8A, Houston, TX 77030, USA.
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3
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Yamane K, Umino Y, Nagami T, Tarumoto K, Hattori K, Maemoto R, Iwasaki J, Kanazawa A. Comparison of Oncological and Perioperative Outcomes Between Self-Expanding Metal Stents and Decompression Tubes for Stages II and III Obstructive Colorectal Cancer: A Retrospective Observational Study. World J Surg 2023; 47:2279-2286. [PMID: 37184666 DOI: 10.1007/s00268-023-07044-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND A bridge to surgery (BTS) using self-expandable metallic stents (SEMSs) is becoming the primary treatment for obstructive colorectal cancer (OCRC). In Japan, intestinal decompression was usually performed using decompression tubes (DTs). However, few reports have compared the outcomes of SEMS and DTs as BTS. Therefore, we compared the treatment outcomes of SEMS and DTs for OCRC. METHODS Data of 80 patients who underwent radical resection after endoscopic decompression for stage II or III OCRC between 2007 and 2021 were retrospectively analyzed. Patients were divided into two groups based on whether they received SEMS (n = 53) or DTs (n = 27). RESULTS The clinical success rate of decompression was 96.2% and 88.9% in the SEMS and DT groups, respectively. Additionally, 96.2% of patients who received SEMS were able to resume their routine diet without stricture symptoms. The rate of stoma construction and incidence of postoperative complications were lower in the SEMS group (p < 0.005 and p < 0.01, respectively). The 3-year relapse-free survival rates were 71.9% and 51.2% in the SEMS and DT groups, respectively, which were not significantly different (p = 0.10). CONCLUSION BTS using SEMS might be an adequate treatment for stage II or III OCRC regardless of tumor location owing to the comparable oncological outcomes with DT and low perioperative complication rate.
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Affiliation(s)
- Kei Yamane
- Department of Surgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo-shi, Shimane, 693-8555, Japan.
| | - Yosuke Umino
- Department of Surgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo-shi, Shimane, 693-8555, Japan
| | - Tadashi Nagami
- Department of Surgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo-shi, Shimane, 693-8555, Japan
| | - Koji Tarumoto
- Department of Surgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo-shi, Shimane, 693-8555, Japan
| | - Kuniaki Hattori
- Department of Surgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo-shi, Shimane, 693-8555, Japan
| | - Ryo Maemoto
- Department of Surgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo-shi, Shimane, 693-8555, Japan
| | - Junji Iwasaki
- Department of Surgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo-shi, Shimane, 693-8555, Japan
| | - Akiyoshi Kanazawa
- Department of Surgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo-shi, Shimane, 693-8555, Japan
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4
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Zeng Z, Liu Y, Wu K, Li D, Lai H, Zhang B. Efficacy and Safety of Fluoroscopy-Guided Self-Expandable Metal Stent Placement for Treatment of Malignant Colorectal Obstruction. Dig Dis Sci 2023; 68:939-947. [PMID: 35653010 DOI: 10.1007/s10620-022-07557-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/02/2022] [Indexed: 12/09/2022]
Abstract
AIM To investigate long-term outcomes after SEMS insertion in patients with malignant colorectal obstruction and to identify the risk factors for complications. METHODS The data of 119 patients with malignant colorectal obstruction who received SEMS insertion between March 2014 and February 2020 were retrospectively analyzed. Patients were divided into two groups according to the intent of treatment, i.e., stenting as "bridge to surgery" (surgical group) and stenting for palliation (palliative group). Technical and clinical success rates and incidence of complications were compared between the two groups. RESULTS The overall technical and clinical success rates were 97.5% and 96.6%, respectively. The technical and clinical success rates and complication rate were comparable between the two groups. In the palliative group, the mean stent patency time was 230 days. Patency rates were not significantly different between primary CRC and recurrent CRC. Incidence of complications was higher in the palliative group than in the surgical group. In multivariate analysis, chemotherapy before stent implantation may increase the risk of stent-related complications, whereas chemotherapy after stent implantation did not. Additionally, the factors independently associated with complications were female sex and preoperative chemotherapy. CONCLUSIONS SEMS under fluoroscopic guidance is a safe and effective treatment for malignant colorectal obstruction. For patients with resectable CRC, stent placement can serve as a bridge to elective surgery. It is worth noting that adjuvant chemotherapy between SEMS and surgery did not increase the complications. For patients with recurrent CRC, stent placement can relieve symptoms, alleviate pain, and improve quality of life.
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Affiliation(s)
- Zhaofei Zeng
- Interventional Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yang Liu
- Interventional Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ketong Wu
- Interventional Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dan Li
- Interventional Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haiyang Lai
- Interventional Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Bo Zhang
- Interventional Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Huang Q, Zou MH, Liang WL, Wei JC, Xie JF, Li YQ, Li WL, Cao J. Colon cancer patient with long-term colon stent placement: Case report and literature review. Front Oncol 2022; 12:972454. [PMID: 36081551 PMCID: PMC9445364 DOI: 10.3389/fonc.2022.972454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer mortality globally. Large bowel obstruction (occurring in 15-30% of patients with CRCs) accounts for approximately 80% of medical emergencies related to CRC. Currently, there is no standard treatment of this condition. The European Society of Gastrointestinal Endoscopy (ESGE) recommends self-expandable metal stent (SEMS) as a bridge (two weeks) to surgery for left-sided obstructing colon cancer. In the present report, we describe an 81-year-old male with colon cancer who underwent colon stent placement for 32 months, but later underwent radical resection. A follow-up of more than four-months revealed that his condition was normal. The history as well as application and advantages of SEMS are discussed in this report.
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Affiliation(s)
- Qing Huang
- Department of Gastrointestinal Surgery, Guangzhou Digestive Disease Center, Guangzhou First People’s Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Min-hong Zou
- Department of Ultrasound, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wen-long Liang
- Department of Gastrointestinal Surgery, Guangzhou Digestive Disease Center, Guangzhou First People’s Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Jian-chang Wei
- Department of Gastrointestinal Surgery, Guangzhou Digestive Disease Center, Guangzhou First People’s Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Jie-feng Xie
- Department of Gastrointestinal Surgery, Guangzhou Digestive Disease Center, Guangzhou First People’s Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Yong-Qiang Li
- Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People’s Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Wang-lin Li
- Department of Gastrointestinal Surgery, Guangzhou Digestive Disease Center, Guangzhou First People’s Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Jie Cao
- Department of Gastrointestinal Surgery, Guangzhou Digestive Disease Center, Guangzhou First People’s Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou, China
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6
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Elgar G, Smiley P, Smiley A, Feingold C, Latifi R. Age Increases the Risk of Mortality by Four-Fold in Patients with Emergent Paralytic Ileus: Hospital Length of Stay, Sex, Frailty, and Time to Operation as Other Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169905. [PMID: 36011537 PMCID: PMC9408669 DOI: 10.3390/ijerph19169905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 05/20/2023]
Abstract
Background: In the United States, ileus accounts for USD 750 million of healthcare expenditures annually and significantly contributes to morbidity and mortality. Despite its significance, the complete picture of mortality risk factors for these patients have yet to be fully elucidated; therefore, the aim of this study is to identify mortality risk factors in patients emergently admitted with paralytic ileus. Methods: Adult and elderly patients emergently admitted with paralytic ileus between 2005−2014 were investigated using the National Inpatient Sample Database. Clinical outcomes, therapeutic management, demographics and comorbidities were collected. Associations between mortality and all other variables were established via univariable and multivariable logistic regression models. Results: A total of 81,674 patients were included, of which 45.2% were adults, 54.8% elderly patients, 45.8% male and 54.2% female. The average adult and elderly ages were 48.3 and 78.8 years, respectively. Elderly patients displayed a significantly (p < 0.01) higher mortality rate (3.0%) than adults (0.7%). The final multivariable logistic regression model showed that for every one-day delay in operation, the odds of mortality for adult and elderly patients increased by 4.1% (p = 0.002) and 3.2% (p = 0.014), respectively. Every additional year of age corresponded to 3.8% and 2.6% increases in mortality for operatively managed adult (p = 0.026) and elderly (p = 0.015) patients. Similarly, non-operatively treated adult and elderly patients displayed associations between mortality and advanced age (p = 0.001). The modified frailty index exhibited associations with mortality in operatively treated adults, conservatively managed adults and conservatively managed elderly patients (p = 0.001). Every additional day of hospitalization increased the odds of mortality in non-operative adult and elderly patients by 7.6% and 5.8%, respectively. Female sex correlated to lower mortality rates in non-operatively managed adult patients (odds ratio = 0.71, p = 0.028). Undergoing invasive diagnostic procedures in non-operatively managed elderly patients related to reduced mortality (odds ratio = 0.78, p = 0.026). Conclusions: Patients emergently admitted for paralytic ileus with increased hospital length of stay, longer time to operation, advanced age or higher modified frailty index displayed higher mortality rates. Female sex and invasive diagnostic procedures were negatively correlated with death in nonoperatively managed patients with paralytic ileus.
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Affiliation(s)
- Guy Elgar
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Parsa Smiley
- School of Engineering, University of Massachusetts at Amherst, Amherst, MA 01003, USA
| | - Abbas Smiley
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
- Correspondence: (A.S.); (R.L.)
| | - Cailan Feingold
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Rifat Latifi
- Minister of Health, 10000 Pristina, Kosovo
- School of Medicine, University of Arizona, Tucson, AZ 85721, USA
- Correspondence: (A.S.); (R.L.)
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7
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Rudiman R. Advances in gastrointestinal surgical endoscopy. Ann Med Surg (Lond) 2021; 72:103041. [PMID: 34888040 PMCID: PMC8636781 DOI: 10.1016/j.amsu.2021.103041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
Surgeons have a role in observing, detect abnormalities, disease, and other deficiencies in function which could be treated. Diagnosing and treating back days were challenging for many reasons. However, technology's innovation enhances surgeons' ability to treat their patients. The term endoscopy refers to the Greek prefix endo- ("within") and the verb skopein ("to view or observe"). Endoscopy is practical both in the diagnosis and treatment of various pathologies. Technological advances, especially in endoscopy, gradually progress and discover many possibilities which allow rapid advancement. Endoscopy development aims to assess human orifice that has not been inspected, probed, and examined over the centuries. Endoscopy over these decades is improving, which led to new problem solving using advanced technological approaches. Thus, a surgeon can solve any issues from examination, diagnosis, and treatment using progressive endoscopy evolution. This review delivers a brief history of advances in surgical endoscopy and describes current endoscopy development.
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Affiliation(s)
- Reno Rudiman
- Division of Digestive Surgery, Department of General Surgery, School of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia
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8
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Zhang S, Liu G, Wu GH, Zhang SW, Zhao YJ, Xu J. Transanal decompression tube is superior to self-expandable metallic colonic stent for malignant colorectal obstruction: a retrospective study. ANZ J Surg 2021; 92:140-145. [PMID: 34636468 DOI: 10.1111/ans.17274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The surgical management of left-sided malignant large bowel obstruction (MLBO) is associated with high morbidity and mortality. Recently, self-expandable metallic colonic stent (SEMS) and transanal decompression tube (TDT) used as a 'bridge to surgery' (BTS) have been widely used. This study aims to compare the clinical outcomes and oncological safety of SEMS and TDT as BTS to transform MLBO into elective surgery. METHODS Between February 2013 and March 2019, 62 patients with MLBO received SEMS (n = 32) or TDT (n = 30), and elective one-stage surgery later. We evaluated decompression efficiency and oncological safety in selective operation in TDT and SEMS groups, including preoperative preparation time, surgical approach, number of lymphatic dissection and vascular invasion, ulcer formation and histopathological findings of resected specimens. RESULTS The preoperative preparation time in the SEMS group was shorter than that of the TDT group (P < 0.05). However, there was no significant difference between the groups in postoperative length of hospital stay (P > 0.05). The number of vascular invasions in the TDT group was less than that in the SEMS group (P < 0.05). Furthermore, the risk of wound abscess and ulcer formation in the TDT group was significantly lower than that in the SEMS group (P < 0.05). CONCLUSION Our findings suggest that SEMS is associated with a relatively poor oncological outcome and the placement of TDT as BTS in MLBO patients may be a better alternation.
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Affiliation(s)
- Shuai Zhang
- Department of General Surgery, Tianjin Union Medical Centre, Tianjin, China
| | - Guang Liu
- Department of Pathology, Tianjin Union Medical Centre, Tianjin, China
| | - Guang-Hai Wu
- Department of General Surgery, Tianjin Union Medical Centre, Tianjin, China
| | - Shi-Wu Zhang
- Department of Pathology, Tianjin Union Medical Centre, Tianjin, China
| | - Yong-Jie Zhao
- Department of General Surgery, Tianjin Union Medical Centre, Tianjin, China
| | - Jing Xu
- Department of General Surgery, Tianjin Union Medical Centre, Tianjin, China
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9
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Book T, Kirstein MM, Schneider A, Manns MP, Voigtländer T. Endoscopic decompression of acute intestinal distension is associated with reduced mortality in critically ill patients. BMC Gastroenterol 2020; 20:87. [PMID: 32252639 PMCID: PMC7137233 DOI: 10.1186/s12876-020-01233-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/24/2020] [Indexed: 12/04/2022] Open
Abstract
Background Endoscopic placement of intestinal decompression tubes is a feasible technique for treatment of acute intestinal dilation. Given the heterogeneity of the underlying diseases leading to intestinal obstruction data on the significance of endoscopic procedures for treatment of these conditions are sparse. Methods In the study period from 2008 to 2019 all patients receiving a decompression tube were identified by retrospective chart review and analyzed. Results A total of 59 decompression tubes were placed in 50 patients. Technical success was achieved in 98% (58/59 tubes). As major complication one small bowel perforation occurred (1/59; 1.7%). Causes for impaired intestinal transit comprised tumor stenoses 22% (11/50), infections 18% (9/50), post-operative paralysis 14% (7/50), neurological diseases 8% (4/50), trauma 2% (1/50) and others 36% (18/50). Most patients (74%; 37/50) were critically ill and treated on intensive care unit. Treatment response after tube insertion was documented in 76% of patients (38/50) whereas 24% (12/50) did not fulfill response criteria. Patients with treatment response showed a significantly better outcome compared to non-responders. Responders had a median survival of 113 days (95% CI 41–186) compared to 15 days (95% CI 6–24) in non-responders (p = 0.002). Analysis of laboratory parameters after stratification in responders and non-responders to endoscopic therapy showed that non-responders had significantly higher levels of CRP and lower platelet count at baseline (CRP 262 mg/L (IQR 101–307) vs. 94 mg/L (IQR 26–153): p = 0.027; platelets 69 thsd/μL (IQR 33–161) vs. 199 thsd/μL (IQR 138–289): p = 0.009). Conclusions Endoscopic decompression is a safe procedure for acute management of impaired intestinal transit even in critically ill patients. Response to therapy is associated with improved outcome and markers of inflammation and organ function such as CRP, platelet count and serum lactate have to be taken into account for therapy monitoring and evaluation of prognosis.
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Affiliation(s)
- Thorsten Book
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Andrea Schneider
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Torsten Voigtländer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
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10
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Xu J, Zhang S, Jiang T, Zhao YJ. Transanal drainage tubes vs metallic stents for acute malignant left-sided bowel obstruction: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e18623. [PMID: 31914042 PMCID: PMC6959871 DOI: 10.1097/md.0000000000018623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/20/2019] [Accepted: 12/06/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The surgical management of acute malignant left-sided bowel obstruction is associated with high morbidity and mortality. Recently, transanal drainage tubes (DTs) and metallic stents (MSs) used as a "bridge to surgery" have become widely used decompression methods compared with emergency surgery. This study aims to evaluate the efficacy and safety of DTs and MSs for the decompression of acute left-sided malignant colorectal obstruction. METHODS All studies were acquired from PubMed, Medline, Embase, CNKI and the Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed with RevMan5.3. Mean differences (MDs), odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The Cochrane Collaboration's risk of bias tool and the Newcastle-Ottawa scale were used to assess the risk of bias. RESULTS Eleven studies, which included three randomized controlled trials (RCTs) and 8 observational studies, were assessed. The methodological quality of the trials ranged from low to moderate. The pooled results of the technical success rate showed that the difference was not statistically significant between the2 devises. The differences in clinical success rate, operative time and complications were statistically significant between MSs and DTs, and MSs were associated with a better clinical success rate, increased operative time and fewer complications. Sensitivity analysis proved the stability of the pooled results, and the publication bias was low. CONCLUSION MS insertion for acute left-sided malignant bowel obstruction is effective and safe with a better technical success rate and with fewer complications than decompression using a DT, and MS insertion can avoid stoma formation. Moreover, MS insertion appears to be a useful treatment strategy for malignant colonic obstruction even if the lesion is located in the right colon. More large-sample, multicenter, high-quality RCTs are needed to verify the outcomes of this meta-analysis.
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11
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Jeong SJ, Park J. Endoscopic Management of Benign Colonic Obstruction and Pseudo-Obstruction. Clin Endosc 2019; 53:18-28. [PMID: 31645090 PMCID: PMC7003002 DOI: 10.5946/ce.2019.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 08/05/2019] [Indexed: 02/07/2023] Open
Abstract
There are a variety of causes of intestinal obstruction, with the most common cause being malignant diseases; however, volvulus, inflammatory bowel disease or diverticulitis, radiation injury, ischemia, and pseudo-obstruction can also cause colonic obstruction. These are benign conditions; however, delayed diagnosis of acute intestinal obstruction owing to these causes can cause critical complications, such as perforation. Therefore, high levels of clinical suspicion and appropriate treatment are crucial. There are variable treatment options for colonic obstruction, and endoscopic treatment is known to be a less invasive and an effective option for such. In this article, the authors review the causes of benign colonic obstruction and pseudo-obstruction and the role of endoscopy in treating them.
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Affiliation(s)
- Su Jin Jeong
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jongha Park
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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12
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Lai H, Wu K, Liu Y, Zeng Z, Zhang B. Fluoroscopy-guided long intestinal tube placement for the treatment of malignant bowel obstruction. Oncol Lett 2019; 17:5154-5158. [PMID: 31186730 DOI: 10.3892/ol.2019.10151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 02/13/2019] [Indexed: 01/11/2023] Open
Abstract
The aim of the present study was to investigate the safety and efficacy of long intestinal tube placement under fluoroscopic guidance for the treatment of malignant bowel obstruction (MBO). The cases of 74 patients with MBO who underwent long intestinal tube placement under fluoroscopic guidance during the period between June 2015 and October 2017 were reviewed. The clinical characteristics were retrospectively analysed with respect to efficacy, safety and outcome. Long intestinal tube placement was successfully completed in all 74 patients. The mean time required for tube placement was 31.09±16.25 min and the mean insertion depth of the tube was 153±39 cm. In 58 cases, the symptoms of abdominal pain, abdominal bloating and vomiting were greatly improved following 1-3 days of tube decompression. The symptoms of the remaining 16 patients were not effectively relieved following decompression. No serious complications were observed in any patients. Overall, for patients with severe MBO, long intestinal tube placement under fluoroscopic guidance appears to be an effective and safe treatment, and it may improve quality of life.
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Affiliation(s)
- Haiyang Lai
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Ketong Wu
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Yang Liu
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Zhaofei Zeng
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Bo Zhang
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510655, P.R. China
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Kojima S, Sakamoto T, Nagai Y, Yajima K. Oral nutrition for left-sided malignant colonic obstruction after decompression with a transanal drainage tube: A case series of 6 patients. Clin Case Rep 2018; 6:1324-1329. [PMID: 29988691 PMCID: PMC6028411 DOI: 10.1002/ccr3.1616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/16/2018] [Accepted: 05/07/2018] [Indexed: 12/30/2022] Open
Abstract
Oral nutrition with a low-residue diet for left-sided malignant colonic obstruction after decompression with a transanal drainage tube is safe and can be considered a viable preoperative management option for appropriate patients.
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Affiliation(s)
- Shigehiro Kojima
- Department of SurgerySainokuni Higashiomiya Medical CenterSaitamaJapan
| | - Tsuguo Sakamoto
- Department of SurgerySainokuni Higashiomiya Medical CenterSaitamaJapan
| | - Yuko Nagai
- Department of SurgerySainokuni Higashiomiya Medical CenterSaitamaJapan
| | - Kazuhito Yajima
- Department of SurgerySainokuni Higashiomiya Medical CenterSaitamaJapan
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14
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Okuda Y, Yamada T, Hirata Y, Shimura T, Yamaguchi R, Sakamoto E, Sobue S, Nakazawa T, Kataoka H, Joh T. Long-term Outcomes of One Stage Surgery Using Transanal Colorectal Tube for Acute Colorectal Obstruction of Stage II/III Distal Colon Cancer. Cancer Res Treat 2018; 51:474-482. [PMID: 29879759 PMCID: PMC6473272 DOI: 10.4143/crt.2018.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/01/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose Since oncological outcomes of transanal colorectal tube (TCT) placement, an endoscopic treatment for colorectal cancer (CRC) with acute colorectal obstruction (ACO), remain unknown, this study analyzed long-term outcomes of TCT placement for stage II/III CRC with ACO. Materials and Methods Data were retrospectively reviewed from consecutive patients with distal stage II/III CRC who underwent surgery between January 2007 and December 2011 at two Japanese hospitals. One hospital conducted emergency surgery and the other performed TCT placement as the standard treatment for all CRCs with ACO. Propensity score (PS) matching was used to adjust baseline characteristics between two groups. Results Among 754 patients with distal stage II/III CRC, 680 did not have ACO (non-ACO group) and 74 had ACO (ACO group). The PS matching between both hospitals identified 234 pairs in the non-ACO group and 23 pairs in the ACO group. In the non-ACO group, the surgical quality was equivalent between the two institutions, with no significant differences in overall survival (OS) and disease-free survival (DFS). In the ACO group, the rate of primary resection/anastomosis was higher in the TCT group than in the surgery group (87.0% vs. 26.1%, p < 0.001). No significant differences were noted between the surgery and the TCT groups in OS (5-year OS, 61.9% vs. 51.5%; p=0.490) and DFS (5-year DFS, 45.9% vs. 38.3%; p=0.658). Conclusion TCT placement can achieve similar long-term outcomes to emergency surgery, with a high rate of primary resection/anastomosis for distal stage II/III colon cancer with ACO.
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Affiliation(s)
- Yusuke Okuda
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nogoya, Japan.,Department of Gastroenterology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Tomonori Yamada
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nogoya, Japan
| | - Yoshikazu Hirata
- Department of Gastroenterology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Takaya Shimura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nogoya, Japan
| | - Ryuzo Yamaguchi
- Department of Surgery, Kasugai Municipal Hospital, Kasugai, Japan
| | - Eiji Sakamoto
- Department of Surgery, Japanese Red Cross Nagoya Daini Hospital, Nogoya, Japan
| | - Satoshi Sobue
- Department of Gastroenterology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Takahiro Nakazawa
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nogoya, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nogoya, Japan
| | - Takashi Joh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nogoya, Japan
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Li D, Du H, Shao G, Xu Y, Li R, Tian Q. Clinical application of transanal ileal tube placement using X-ray monitoring. Oncol Lett 2016; 13:137-140. [PMID: 28123533 PMCID: PMC5244971 DOI: 10.3892/ol.2016.5443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/29/2015] [Indexed: 11/25/2022] Open
Abstract
Colorectal cancer, which includes colon and rectal cancer, is a common digestive tract tumor. Although surgery is the primary form of treatment, there are a number of drawbacks, including patients experiencing considerable pain and high cost. The present study was undertaken to examine the clinical value of transanal ileal tube placement under X-ray monitoring. Thirty-six cases of left colon obstruction presenting to our hospital between July 2011 and February 2014, underwent transanal ileal tube placement using a single-curve catheter guided by a guidewire under X-ray monitoring. An ileal tube was successfully inserted into 32 patients. Clinical symptoms were alleviated effectively within 48 h. Indwelling catheter decompression time was 4–9 days with an average of 5.61 days. In two cases, the colon guidewire perforated into the abdominal cavity. Repeated exploration resistance of the guidewire and catheter indicated stenosis at this position owing to obstruction. In conclusion, transanal placement of the ileal tube through X-ray monitoring is capable of effectively alleviating the symptoms of ileus. Thus, this constitutes a safe, effective, and economical method that is acceptable to patients.
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Affiliation(s)
- Dechun Li
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Hongtao Du
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Guoqing Shao
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Yuanshun Xu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Ruihong Li
- Department of Gastroenterology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Qingzhong Tian
- Department of General Surgery, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
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Abstract
Acute malignant colorectal obstruction (AMCO) is an emergency associated with colorectal cancer (CRC). Emergency surgery is standard therapy for AMCO, and 1-stage surgery without colostomy is preferable, but it is occasionally difficult in the emergency setting. A self-expandable metallic stent (SEMS) enables noninvasive colonic decompression and subsequent 1-stage surgery, which has been widely applied for CRC with AMCO. However, recent accumulation of high-quality evidence has highlighted some problems and the limited efficacy of SEMS for AMCO. In palliative settings, SEMS placement reduces hospital stay and short-term complication rates, whereas it increases the frequency of long-term complications, such as delayed perforation. SEMS placement does not seem compatible with recent standard chemotherapy including bevacizumab. As a bridge to surgery, while SEMS placement provides a lower clinical success rate than emergency surgery, it can facilitate primary anastomosis without stoma. However, evidence regarding long-term survival outcomes with SEMS in both palliative and bridge to surgery settings is lacking. The efficacy of transanal colorectal tube placement, another endoscopic treatment, has been reported, but its clinical evidence level is low due to the limited number of studies. This review article comprehensively summarizes the current knowledge about surgical and endoscopic management of CRC with AMCO.
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Shigeta K, Okabayashi K, Baba H, Hasegawa H, Tsuruta M, Yamafuji K, Kubochi K, Kitagawa Y. A meta-analysis of the use of a transanal drainage tube to prevent anastomotic leakage after anterior resection by double-stapling technique for rectal cancer. Surg Endosc 2015; 30:543-550. [PMID: 26091985 DOI: 10.1007/s00464-015-4237-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/14/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The safety and efficacy of transanal drainage tube (TDT) placement to decrease the risk of postoperative anastomotic leakage after rectal cancer surgery has not been validated. The objective of this meta-analysis was to evaluate the usefulness of a TDT for the prevention of anastomotic leakage after an anterior resection for rectal cancer. METHODS The PubMed and Cochrane Library databases were searched for studies comparing TDT and non-TDT. The endpoint utilized in this study was defined as the rates of anastomotic leakage and re-operation. The relative effects of these variables were synthesized using Review Manager 5.1 software. RESULTS Four trials including 909 participants (401 TDT cases and 508 non-TDT cases) met our inclusion criteria. The weighted mean anastomotic leakage rate was 4% [95% confidence interval (CI) 1-6%], and a significantly lower risk of anastomotic leakage was identified in the TDT group compared with the non-TDT group [odds ratio (OR) 0.30; 95% CI 0.16-0.55; p = 0.0001]. Furthermore, there were significant differences between the TDT and non-TDT groups in terms of the re-operation rate (OR 0.18; 95% CI 0.07-0.44; p = 0.0002). No significant covariates related to anastomotic leakage or re-operation were identified in meta-regression analysis. Both the anastomotic leakage and re-operation rates for all studies lay inside the 95% confidence interval boundaries. No visible publication bias was found by visual assessment of the funnel plot (Egger's test; anastomotic leakage: p = 0.056, re-operation: p = 0.681). CONCLUSIONS Placement of a TDT is an effective and safe procedure that can decrease the rate of anastomotic leakage and re-operation after an anterior resection.
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Affiliation(s)
- Kohei Shigeta
- Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Department of Surgery, Saitama City Hospital, Saitama, Japan.
| | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Hideo Baba
- Department of Surgery, Saitama City Hospital, Saitama, Japan
| | - Hirotoshi Hasegawa
- Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masashi Tsuruta
- Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuo Yamafuji
- Department of Surgery, Saitama City Hospital, Saitama, Japan
| | - Kiyoshi Kubochi
- Department of Surgery, Saitama City Hospital, Saitama, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Chen SJ, Huang ZH, Guo CS. Colorectal stenting vs ileus tube drainage for treatment of acute malignant colorectal obstruction. Shijie Huaren Xiaohua Zazhi 2014; 22:4036-4040. [DOI: 10.11569/wcjd.v22.i26.4036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the effect of endoscopic colorectal stenting vs ileus tube drainage for treatment of acute malignant colorectal obstruction.
METHODS: With the aid of fluoroscopy, 45 patients with acute malignant colorectal obstruction were treated by endoscopic colorectal stenting (n = 27) or ileus tube drainage (n = 18). Postoperative remission and complications were compared between the two groups.
RESULTS: The technical success rate of colorectal stenting was 96.3%, and that of ileus tube drainage was 100%. Relief of symptoms occurred within 1-4 d. Thirty-eight patients underwent subsequent elective surgical resection 6-8 d after obstruction relief, without complications of anastomotic leakage or intraperitoneal infection.
CONCLUSION: Preoperative stenting and ileus tube drainage in acute colonical obstruction can effectively relieve obstruction and improve the quality of life, although each has its own advantages and disadvantages.
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Sumise Y, Yoshioka K, Okitsu N, Kamo H, Arakawa Y, Yamaguchi T, Harino Y, Nakai Y, Yamanaka A, Tashiro S. Outcome of emergency one-stage resection and anastomosis procedure for patients with obstructed colorectal cancer. THE JOURNAL OF MEDICAL INVESTIGATION 2014; 60:249-55. [PMID: 24190043 DOI: 10.2152/jmi.60.249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
PURPOSES The purpose of this study was to verify the outcome of the emergency one stage resection and anastomosis procedure for patients with obstructed colorectal cancer. METHODS An emergency one stage resection and anastomosis procedure was performed for 40 patients with obstructive colorectal cancer. The outcome was verified and compared dividing into two groups. 17 patients under the age of 70 in (Group A), 23 patients 70 years and over in (Group B). RESULTS The operative mortality rate in both groups was 0%. As a result, postoperative complications were not significantly different between the two groups. The overall survival rate after a 5-year period in both groups was 41.8%, regarding all patients and the survival curves for the two groups, was not significantly different. The 5 year survival rate in stage II or III showed no differences between the two groups. CONCLUSION The one-stage resection and anastomosis of the large bowel could be applied safely to emergency patients, which in turn allows for excellent short-term operative results in both groups mentioned. This particular procedure should be positively enforced, even in elderly patients in their 70's.
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20
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Shigeta K, Baba H, Yamafuji K, Kaneda H, Katsura H, Kubochi K. Outcomes for patients with obstructing colorectal cancers treated with one-stage surgery using transanal drainage tubes. J Gastrointest Surg 2014; 18:1507-13. [PMID: 24871080 DOI: 10.1007/s11605-014-2541-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/13/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute colorectal obstruction requires immediate surgical treatment. Although one-stage surgery with transanal drainage tubes (TDT) is reportedly safe and feasible, the long-term outcome of this procedure remains unclear. AIM To assess the outcome of one-stage surgery using TDT in the acute left colon or rectal obstructions due to colorectal carcinomas. METHODS Clinicopathological data were recorded from patients with colorectal cancer with acute obstructions between 2006 and 2013. RESULTS A total of 43 patients were enrolled including 29 males and 14 females. Among 39 patients, TDT was successful in 33 (84 %) and was incomplete in 6. Thus, 33 patients received one-stage surgery with TDT decompression, and 9 patients, including 6 with incomplete decompression, received one-stage surgery with no decompression. No significant differences in clinicopathological factors were observed between decompression and non-decompression groups. Adjusted analyses revealed that decompression using TDT was significantly associated with OS (hazard ratio 0.24; 95 % confidence interval, 0.08-0.72; p = 0.01). Furthermore, OS in the TDT decompression group was significantly longer than that in the non-decompression group (p = 0.01). CONCLUSIONS One-stage surgery with decompression using TDT may be effective to avoid stomas and to improve overall survival in patients with obstructing colorectal cancers.
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Affiliation(s)
- Kohei Shigeta
- Department of Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku, Saitama-shi, Saitama, 336-8522, Japan,
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21
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The evolution of surgery for the treatment of malignant large bowel obstruction. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2014.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Lujan HJ, Barbosa G, Zeichen MS, Mata WN, Maciel V, Plasencia G, Hartmann RF, Viamonte M, Fogel R. Self-expanding metallic stents for palliation and as a bridge to minimally invasive surgery in colorectal obstruction. JSLS 2013; 17:204-11. [PMID: 23925013 PMCID: PMC3771786 DOI: 10.4293/108680813x13654754534990] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Self-expanding metallic stents are effective for the palliation of malignant obstruction. This study indicates that stents for bowel obstruction may allow for minimally invasive surgical intervention with a shorter hospital stay, lower stoma rate, and earlier chemotherapy administration. Background and Objectives: Acute colorectal obstruction is a potentially life-threatening emergency that requires immediate surgical treatment. Emergency procedures had an associated mortality rate of 10% to 30%. This encouraged development of other options, most notably self-expanding metallic stents. The primary endpoint of this study to is to report our group's experience. Methods: We performed a retrospective review of 37 patients who underwent self-expanding metallic stent placement for colorectal obstruction between July 2000 and May 2012. Data collected were age, comorbidities, diagnosis, intent of intervention (palliative vs bridge to surgery), complications, and follow-up. Results: The study comprised 21 men (56.76%) and 16 women (43.24%), with a mean age of 67 years. The intent of the procedure was definitive treatment in 22 patients (59.46%) and bridge to surgery in 15 (40.54%). The highest technical success rate was at the rectosigmoid junction (100%). The causes of technical failure were inability of the guidewire to traverse the stricture and bowel perforation related to stenting. The mean follow-up period was 9.67 months. Pain and constipation were the most common postprocedure complications. Discussion: The use of a self-expanding metallic stent has been shown to be effective for palliation of malignant obstruction. It is associated with a lower incidence of intensive care unit admission, shorter hospital stay, lower stoma rate, and earlier chemotherapy administration. Laparoscopic or robotic surgery can then be performed in an elective setting on a prepared bowel. Therefore the patient benefits from advantages of the combination of 2 minimally invasive procedures in a nonemergent situation. Further large-scale prospective studies are necessary.
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Kang CB, Liu JH, Li XB, Lin DP, Ye B, Li XW, Chen XF, Liu QL, Zhang P, Li D. Application of naso-intestinal decompression tubes in patients with acute paralytic intestinal obstruction. Shijie Huaren Xiaohua Zazhi 2013; 21:2470-2474. [DOI: 10.11569/wcjd.v21.i24.2470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the use of naso-intestinal decompression tubes (NDTs) in patients with acute paralytic intestinal obstruction.
METHODS: Clinical data for 48 patients with acute paralytic intestinal obstruction treated from November 2010 to March 2013 were retrospectively analyzed. NDTs were placed under gastroscopic guidance to the upper jejunum to conduct gastrointestinal decompression in 21 cases (treatment group), and traditional nasal gastric tubes were placed to perform conventional gastrointestinal decompression in 27 cases (control group). Gastrointestinal drainage volume, waist circumference reduction, indwelling time, length of hospital stay, catheter obstruction rate and mortality rate were compared between the two groups.
RESULTS: Drainage volume (926 mL ± 243 mL vs 926 mL ± 243 mL, P < 0.05) and waist circumference reduction (12.6 cm ± 4.1 cm vs 5.4 cm ± 3.5 cm, P < 0.05) were significantly more in the treatment group than in the control group. The rate of catheter obstruction (4.8% vs 40.7%, P < 0.05), indwelling time (8.3 d ± 3.9 d vs 13.4 d ± 5.6 d, P < 0.05), and hospitalization time (12.1 d ± 4.8 d vs 17.5 d ± 6.1d, P < 0.05) were significantly lower in the treatment group than in the control group. No significant difference was found in mortality between the two groups (4.76% vs 7.40%, P > 0.05).
CONCLUSION: NDTs are superior to traditional nasogastric tubes in the management of acute paralytic intestinal obstruction.
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Shingu Y, Hasegawa H, Sakamoto E, Komatsu S, Kurumiya Y, Norimizu S, Taguchi Y. Clinical and oncologic safety of laparoscopic surgery for obstructive left colorectal cancer following transanal endoscopic tube decompression. Surg Endosc 2013; 27:3359-63. [PMID: 23549762 DOI: 10.1007/s00464-013-2917-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 03/03/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Little information has been available concerning the safety of laparoscopic resection of obstructive colorectal cancer after transanal endoscopic tube decompression (TETD). The aim of this study was to assess the short- and long-term outcomes of laparoscopic surgery following TETD for such advanced colorectal cancer. METHODS A retrospective review was performed of 40 patients with obstructive left colorectal cancer whose distended bowels were treated with TETD before laparoscopic surgery, between January 2001 and March 2011 (TETD group). The elective surgery resulted in potentially curative resection of the tumor in all cases. Their clinical records were compared to those of 80 matched controls with nonobstructive left colorectal cancer resected laparoscopically during the same period (control group). RESULTS Operative time, blood loss, and the rate of conversion to laparotomy were comparable between the two groups. There were no significant between-group differences in morbidity rates. Five-year overall survival rates in the TETD and control groups were 71.9 and 75.4%, respectively, with no statistical difference. Disease-free survival rates after 5 years were also similar (TETD group, 64.5% vs. control group, 66.3%). There were no significant differences between the two groups in recurrence rates and patterns. CONCLUSION These results suggest that laparoscopic surgery following TETD is clinically and oncologically safe and could be a treatment of choice for obstructive left colorectal cancer.
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Affiliation(s)
- Yuji Shingu
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466-8650, Japan.
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Ding XL, Li YD, Yang RM, Li FB, Zhang MQ. A temporary self-expanding metallic stent for malignant colorectal obstruction. World J Gastroenterol 2013; 19:1119-1123. [PMID: 23467379 PMCID: PMC3582001 DOI: 10.3748/wjg.v19.i7.1119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/11/2013] [Accepted: 01/24/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical safety and efficacy of a temporary self-expanding metallic stent (SEMS) for malignant colorectal obstruction.
METHODS: From September 2007 to June 2012, 33 patients with malignant colorectal obstruction were treated with a temporary SEMS. The stent had a tubular configuration with a retrieval lasso attached inside the proximal end of the stent to facilitate its removal. The SEMS was removed one week after placement. Clinical examination, abdominal X-ray and a contrast study were prospectively performed and both initial and follow-up data before and at 1 d, 1 wk, and 1 mo, 3 mo, 6 mo and 12 mo after stent placement were obtained. Data collected on the technical and clinical success of the procedures, complications, need for reinsertion and survival were analyzed.
RESULTS: Stent placement and removal were technically successful in all patients with no procedure-related complications. Post-procedural complications included stent migration (n = 2) and anal pain (n = 2). Clinical success was achieved in 31 (93.9%) of 33 patients with resolution of bowel obstruction within 3 d of stent removal. Eleven of the 33 patients died 73.81 ± 23.66 d (range 42-121 d) after removal of the stent without colonic re-obstruction. Clinical success was achieved in another 8 patients without symptoms of obstruction during the follow-up period. Reinsertion of the stent was performed in the remaining 12 patients with re-obstruction after 84.33 ± 51.80 d of follow-up. The mean and median periods of relief of obstructive symptoms were 97.25 ± 9.56 d and 105 ± 17.43 d, respectively, using Kaplan-Meier analysis.
CONCLUSION: Temporary SEMS is a safe and effective approach in patients with malignant colorectal obstruction due to low complication rates and good medium-term outcomes.
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Horiuchi A, Nakayama Y, Kajiyama M, Kamijima T, Kato N, Ichise Y, Tanaka N. Endoscopic decompression of benign large bowel obstruction using a transanal drainage tube. Colorectal Dis 2012; 14:623-627. [PMID: 21689313 DOI: 10.1111/j.1463-1318.2011.02624.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Endoscopic decompression of malignant colorectal obstruction is often dealt with using expandable metallic stents. Endoscopic decompression of benign large bowel obstruction is more difficult. We report the technique and outcome of transanal endoscopic decompression for benign large bowel obstruction. METHOD From January 2001 to June 2010, endoscopic decompression using a transanal drainage tube placement was attempted in consecutive patients with benign large bowel obstruction. The clinical features, technical success, complications, treatment after the tube placement and clinical success were retrospectively evaluated. RESULTS There were 13 patients (seven males, age 47-87, mean 69 years). The sites of obstruction were transverse colon [5 (38%)], sigmoid colon [3 (23%)], ileocecal valve [2 (15%)], splenic flexure [1 (8%)], descending colon [1 (8%)] and rectum [1 (8%)]. The most common cause of obstruction was anastomotic stricture [9 (69%)]. In 12 (92%) patients transanal decompression was technically successful with one perforation. An overtube, the reinsertion of colonoscope along the decompression tube, or the use of a small-diameter endoscope was required for the tube placement in seven (54%). In seven (54%) patients tube placement alone resulted in relief of bowel obstruction without operation. CONCLUSION Endoscopic decompression using a transanal drainage tube is effective for the management of benign large bowel obstruction.
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Affiliation(s)
- A Horiuchi
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan.
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Chou SQH, Song HY, Kim JH, Park JH, Fan Y, Lee H, Yoon YS, Kim JC. Dual-design expandable colorectal stent for a malignant colorectal obstruction: preliminary prospective study using new 20-mm diameter stents. Korean J Radiol 2012; 13:66-72. [PMID: 22247638 PMCID: PMC3253405 DOI: 10.3348/kjr.2012.13.1.66] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 09/01/2011] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To evaluate the safety and effectiveness of a 20-mm diameter dual-design expandable colorectal stent for malignant colorectal obstruction. MATERIALS AND METHODS The study series included 34 patients with malignant colorectal obstruction who underwent implantation of a 20-mm dual-design expandable colorectal stent in our department between March 2009 and June 2010. The 20-mm dual-design expandable colorectal stent was placed by using a 3.8-mm delivery system that had 28-mm diameter proximal and distal ends. Among the 34 patients, stent placement for palliation was performed in 20 patients, while stent placement for bridge to surgery was performed in 14 patients. RESULTS A 97% (33 of 34) success rate was achieved for the stent placement. The perforation rate in the bridge to surgery group was 7% (1 of 14), compared to 0% (0 of 19) in palliative group. Migration occurred in one of 33 patients (3%) at 30 days after stent placement. CONCLUSION The placement of a 20-mm diameter dual-design stent appears to be clinically safe and effective for the management of colorectal obstruction, with low perforation and migration rates.
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Affiliation(s)
- Sandas Qi Hua Chou
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
- Department of Radiology & Imaging, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Ho-Young Song
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Jung-Hoon Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Yong Fan
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Heuiran Lee
- Department of Microbiology, Bio-Medical Institute Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Yong Sik Yoon
- Department of Colorectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Jin Cheon Kim
- Department of Colorectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
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Abstract
Emergency management of obstructing colonic cancer depends on both tumor location and stage, general condition of the patient and surgeon's experience. Right sided or transverse colon obstructing cancers are usually treated by right hemicolectomy-extended if necessary to the transverse colon-with primary anastomosis. For left-sided obstructing cancer, in patients with low surgical risk, primary resection and anastomosis associated with on-table irrigation or manual decompression can be performed. It prevents the confection of a loop colostomy but presents the risk of anastomotic leakage. Subtotal or total colectomy allows the surgeon to encompass distended and fecal-loaded colon, and to perform one-stage resection and anastomosis. Its disadvantage is an increased daily frequency of stools. It must be performed only in cases of diastatic colon perforation or synchronous right colonic cancer. In patients with high surgical risk, Hartmann procedure must be preferred. It allows the treatment of both obstruction and cancer, and prevents anastomotic leakage but needs a second operation to reverse the colostomy. Colonic stenting is clinically successful in up to 90% in specialized groups. It is used as palliation in patients with disseminated disease or bridge to surgery in the others. If stent insertion is not possible, loop colostomy is still indicated in patients at high surgical risk.
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Affiliation(s)
- A Gainant
- Department of Digestive Surgery, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
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Fisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, Early DS, Evans JA, Fanelli RD, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Malpas PM, Sharaf RN, Shergill AK, Dominitz JA. Complications of colonoscopy. Gastrointest Endosc 2011; 74:745-52. [PMID: 21951473 DOI: 10.1016/j.gie.2011.07.025] [Citation(s) in RCA: 217] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 07/15/2011] [Indexed: 12/17/2022]
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Gash K, Chambers W, Ghosh A, Dixon AR. The role of laparoscopic surgery for the management of acute large bowel obstruction. Colorectal Dis 2011; 13:263-6. [PMID: 19906058 DOI: 10.1111/j.1463-1318.2009.02123.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM The aim of this study was to analyse the outcome of laparoscopic management of large bowel obstruction (LBO). METHOD A prospective electronic database (April 2001-June 2009) was used to identify outcomes in consecutive patients presenting with LBO. RESULTS Twenty-four patients (13 male) median age 68 years (range 56-92 years), ASA grade I (2), II (6), III (14) and IV (2), underwent surgery for LBO secondary to cancer (21) and diverticulosis (3). Supervised trainees performed four operations. Operations included anterior resection (10), Hartmann's resection (6), right/extended hemicolectomy (7) and colectomy with ileorectal anastomosis (1). The median operating time was 100 min (range 65-180 min). There were two (8%) conversions. The median time to normal diet was 24 h (range 2-192 h) and median hospital stay 3 days (range 1-30 days). Complications, seen in six patients, included atrial fibrillation (2), wound infection (2), ileus (2), CO(2) retention (1), stoma necrosis (1), circulatory collapse/bowel ischaemia (1) and anastomotic leak (1). There was one (4%) readmission and two (8%) returns to theatre. One patient died. CONCLUSION Laparoscopic resectional surgery in acute LBO is feasible and safe with a low complication rate that enables early hospital discharge.
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Affiliation(s)
- K Gash
- Department of Colorectal Surgery, Frenchay Hospital, Bristol, UK
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Ichise Y, Horiuchi A, Nakayama Y, Tanaka N. Techniques and Outcomes of Endoscopic Decompression Using Transanal Drainage Tube Placement for Acute Left-sided Colorectal Obstruction. Gastroenterology Res 2010; 3:201-206. [PMID: 27956997 PMCID: PMC5139716 DOI: 10.4021/gr233w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2010] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND If it is possible, endoscopic decompression for acute left-sided colorectal obstruction will be effective in critically ill patients. This study was to evaluate the techniques and outcomes of transanal drainage tube placement following urgent colonoscopy in management of acute left-sided colorectal obstruction. METHODS From January 2000 to December 2009, 69 consecutive patients (36 males, age 38 to 94, mean = 71) were hospitalized because of acute left-sided colorectal obstruction. Urgent colonoscopy was performed within 12 hours of entry for diagnosis and treatment (mean time, 6.5 hours). Endoscopic decompression using a transanal drainage tube was attempted. Clinical success, methods used, and complications were retrospectively evaluated. RESULTS The cause of obstruction was colorectal carcinoma in 66 patients (96%). The site of obstruction was sigmoid colon in 37 (54%), rectum in 20 (29%), and descending colon in 12 (17%). Out of 69 patients, endoscopic decompression using the transanal drainage tube was successful in 66 (96%). The use of combination of transanal drainage tube and the equipped guidewire enabled endoscopic decompression was successful in 45 patients (65%), though a small-diameter upper endoscope was used in 2 patients to introduce the guidewire beyond the obstruction. Perforation during the placement developed in 2 patients and one patient was unsuccessful. CONCLUSIONS Transanal drainage tube placement following urgent colonoscopy was effective in the management of acute left-sided colorectal obstruction. In the majority of patients, the materials and methods used for the transanal drainage tube placement were simple and easy.
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Affiliation(s)
- Yasuyuki Ichise
- Digestive Disease Center, Showa Inan General Hospital, 3230 Akaho, Komagane, Japan
| | - Akira Horiuchi
- Digestive Disease Center, Showa Inan General Hospital, 3230 Akaho, Komagane, Japan
| | - Yoshiko Nakayama
- Digestive Disease Center, Showa Inan General Hospital, 3230 Akaho, Komagane, Japan; Department of Pediatrics, Shinshu University School of Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Naoki Tanaka
- Digestive Disease Center, Showa Inan General Hospital, 3230 Akaho, Komagane, Japan; Department of Metabolic Regulation, Shinshu University Graduate School of Medicine, Matsumoto, Japan
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Harrison ME, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, Cash BD, Fanelli RD, Fisher L, Fukami N, Gan SI, Ikenberry SO, Jain R, Khan K, Krinsky ML, Maple JT, Shen B, Van Guilder T, Baron TH, Dominitz JA. The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudo-obstruction. Gastrointest Endosc 2010; 71:669-79. [PMID: 20363408 DOI: 10.1016/j.gie.2009.11.027] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 11/13/2009] [Indexed: 02/06/2023]
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Xu K, Zhang H, Feng Y, Cong JC, Chen CS, Liu EQ. Comparison of the outcomes of preoperative stent insertion and emergency surgery in the treatment of obstructive left-sided colorectal cancer: an analysis of 248 cases. Shijie Huaren Xiaohua Zazhi 2010; 18:736-740. [DOI: 10.11569/wcjd.v18.i7.736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy and safety of self-expanding metallic stents (SEMSs) and to compare the short- and long-term outcomes of preoperative stent insertion and emergency surgery in the treatment of obstructive left-sided colorectal cancer.
METHODS: Sixty-two patients who underwent SEMS insertion and 186 patients who underwent primary emergency surgery for left-sided colorectal cancer from 2000 to 2008 were retrospectively analyzed.
RESULTS: The SEMSs were placed successfully in 61 patients, of which 14.5% developed complications such as perforating and migration. Primary anastomosis rate was higher in patients undergoing stent insertion than in those undergoing emergency surgery (87.1% vs 34.4%, P = 0.001). The complication rate was higher in patients undergoing emergency surgery than in those undergoing stent insertion (47.3% vs 17.7%, P = 0.000). No significant difference was noted in the survival curve between the two groups (P = 0.497).
CONCLUSION: Preoperative stent insertion is safe and effective in the treatment of obstructive left-sided colorectal cancer and may result in a higher primary anastomosis rate. Stent insertion does not seem to have a deleterious effect on prognosis.
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Li YD, Cheng YS, Li MH, Fan YB, Chen NW, Wang Y, Zhao JG. Management of acute malignant colorectal obstruction with a novel self-expanding metallic stent as a bridge to surgery. Eur J Radiol 2010; 73:566-571. [PMID: 19167177 DOI: 10.1016/j.ejrad.2008.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 12/02/2008] [Accepted: 12/02/2008] [Indexed: 02/07/2023]
Abstract
PURPOSE To prospectively evaluate the safety and clinical efficacy of a newly designed self-expandable metallic stent (SEMS) in the treatment of patients with acute malignant colorectal obstruction. METHODS Between April 2001 and October 2007, 52 patients with acute malignant colorectal obstruction were treated with a new designed SEMS as an investigational bridge to surgery. Patients were prospectively followed and relevant data collection was collected, including details regarding technique, clinical symptoms, complications, need for elective surgery, and overall survival. RESULTS Stent placement was technically successful in all but two patients (due to complete obstruction) with no procedure-related complications. Complications included stent migration (n=4), anal pain (n=2) and stool impaction (n=1). Clinical success was achieved in 49 (98%) of 50 patients with resolution of bowel obstruction within 2 days of stent placement. In one patient with stool impaction 2 days after stent placement, endoscopic disimpaction was successfully performed. An elective one-stage surgical procedure was performed in all 50 patients who successfully received a SEMS as a bridge to surgery within a mean of 8+/-2 days (range: 4-11 days) after stent placement. Mean follow-up time was 36+/-12 months (range 3-70 months), and all patients remained alive at the time of this report. CONCLUSION The newly designed SEMS placement as a bridge to surgery was a safe and effective intervention for colonic decompression in patients with acute malignant colorectal obstruction and allowed a high proportion of patients to be successfully proceeded to elective surgery.
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Affiliation(s)
- Yong-Dong Li
- Department of Radiology and Research Institute of Radiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
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Dual-design expandable colorectal stent for malignant colorectal obstruction: comparison of flared ends and bent ends. AJR Am J Roentgenol 2009; 193:248-54. [PMID: 19542421 DOI: 10.2214/ajr.08.2003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to compare, focusing on colonic perforation and stent migration, the clinical safety and efficacy of dual-design expandable colorectal stents with flared ends with those of stents with bent ends in the treatment of patients with malignant colorectal obstruction. SUBJECTS AND METHODS A total of 122 patients with malignant colorectal obstruction underwent implantation of dual-design stents with flared (n = 69) or bent (n = 53) ends. RESULTS Stent placement was technically successful in 116 of 122 patients (95.1%), 65 of 69 patients (94.2%) with flared-end stents and 51 of 53 patients (96.2%) with bent-end stents (p > 0.05). Clinical success was achieved within 2 days in 61 of 65 patients (93.8%) with bent-end stents and in 46 of 51 patients (90.2%) with flared-end stents (p > 0.05). Complications included seven cases of colonic perforation (6%), seven cases of stent migration (6%), three cases of tumor overgrowth (2.6%), four cases of severe rectal pain (3.4%), and four cases of bleeding (3.4%). There were no significant differences between the rates of colonic perforation and stent migration in the two groups (6.2% vs 5.9%), and the overall complication rates were similar (p > 0.05). CONCLUSION Dual-design expandable colorectal stents with flared ends and those with bent ends are equally safe and effective, having similar perforation and migration rates.
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Abstract
PURPOSE OF REVIEW Over the past 15 years, great strides have been made in the nonsurgical management of malignant large bowel obstruction. Progress continues, particularly in the area of self-expanding metal stents. The purpose of this review is to assess the available endoscopic techniques for colonic decompression and document the inexorable trend toward supremacy of the self-expanding metal stent in this arena. RECENT FINDINGS Stents are being designed with the structure and function of the colon in mind allowing better and longer-lasting palliation. Improvement in the design of the colonic decompression tube allows a low-tech approach to the palliation of colonic obstruction. Argon plasma coagulation is helpful in restoring continuity of the obstructed colonic lumen in certain circumstances. SUMMARY As a consequence of technological innovation and growing expertise in the community, gastroenterology is becoming the go to specialty in the early management and palliation of malignant bowel obstruction.
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