P306 Stenting for colorectal cancer: are we adhering to guidelines? An overview at a district general hospital

• Published in: Gut Vol. 70; no. Suppl 1; p. A199
• Main Authors: Mohandas, Dhanoop, Sinha, Ashnish, Mead, Robert, Greenfield, Simon, Rowlands, David
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.01.2021
• Subjects: Cancer; Colorectal cancer; Colorectal carcinoma; Endoscopy; Implants; Metastases; Mortality; Palliation; Patients; Spleen; Stents; Surgery; Survival
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2020-bsgcampus.380

IntroductionColorectal stenting provides an option for treating and preventing BO, improving symptoms while occasionally bridging to surgery for colorectal cancer (CRC). NICE suggests self-expanding metal stent (SEMS) for the initial management of left sided CRC causing acute BO while ESGE advises SEMS as palliation tool in malignant obstruction or in patients with a high risk of postoperative mortality1. We audited patients with CRC treated with colonic stenting locally to investigate compliance with guidelines and outcomes.MethodsIn this retrospective study, cases of colonic stenting for CRC over a 5 year period from 1/12/2014 to 1/12/2019 were identified via CIPTS (Delian Systems) an online database of endoscopic procedures. Further demographic and outcome measures including procedure complications, 30-day mortality, intervention location and stent type were collected.ResultsOverall 40 patients underwent colonic stenting with Boston Scientific Wireflex stents performed by 3 operators. 42 cases occurred due to two cases of stent migration requiring revision. The mean population age was 77 years with a female preponderance (N=23,57.5%). Overall 30 day mortality was 10% (N=4) whilst 90 day survival was 70% (N=28). Three patients had stenting as bridge therapy to surgical intervention. Complication rates were low with only stent migration (N=2), wire perforation(N=1) and stent fracture(N=1, no reintervention needed) occurring. Therapy was predominantly for Sigmoid lesions(N=21) followed by Descending Colon(N=11) and Splenic Flexure(N=3).ConclusionsColonic stenting is an effective palliation therapy for obstructing CRC. It is efficacious with low complication rates. Mortality data is comparable to reported emergency surgical data. Survival to 90 days was promising considering many patients had significant comorbidities or metastatic disease when stented. Three cases were bridged to surgery with stenting for optimisation, though not recommended by ESGE. Post-operative and surgical costs were negated with one patient requiring admission post stenting. We acknowledge the low number of patients but offer evidence that our stenting service run by experienced operators is successful. We appreciate that, in general, stenting was compliant with current ESGE guidance.1 We aim to further collate surgical CRC treatment data over this period and compare outcomes.ReferencesVan Hooft et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. DOI http://dx.doi.org/10.1055/s-0034-1390700Endoscopy 2014; 46: 990–1002