Technical and Clinical Outcomes Following Colonic Stenting: A Seven-Year Analysis of 268 Procedures

• Published in: Cardiovascular and interventional radiology Vol. 39; no. 10; pp. 1471 - 1478
• Main Authors: Little, M. W., Oakley, T., Briggs, J. H., Sutcliffe, J. A., Allouni, A. K., Makris, G., Bratby, M. J., Tapping, C. R., Patel, R., Wigham, A., Anthony, S., Phillips-Hughes, J., Uberoi, R.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2016; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Cardiology; Clinical Investigation; Clinical outcomes; Colonic Diseases - therapy; Colorectal Neoplasms - therapy; Diverticulosis, Colonic - therapy; Female; Humans; Imaging; Intestinal Obstruction - therapy; LARGE INTESTINE; Male; Medicine; Medicine & Public Health; Middle Aged; MORTALITY; Nuclear Medicine; PATIENTS; PERFORATION; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; REDUCTION; Stents - adverse effects; SURGERY; SYMPTOMS; Treatment Outcome; Ultrasound; VASCULAR DISEASES; Clinical Success; Stent Migration; Clinical Success Rate; Technical Success; Technical Success Rate
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-016-1391-5

Aims To assess the factors contributing to the technical and clinical success of colorectal stenting for large bowel obstruction. Methodology 268 cases of colonic stenting for large bowel obstruction were performed in 249 patients of mean age of 72 years (28–98) between 2006 and 2013. The majority of strictures were due to malignant disease, 244/268 (91 %). Diverticular strictures accounted for 24/268 (9 %). Results Overall technical success rate was 81 % (217/268), with a clinical success rate of 65 % (174/268). Duration of symptoms ranged from 0 to 180 days (mean 8 days). Technical success rate was seen to decrease with increasing symptom duration. For symptom duration of less than 1 week, technical success was 85.4 % (181/212) versus 69.6 % (39/56) for those with symptoms of greater than a week ( p  < 0.05). Clinical success rates fell from 71.3 % (107/150) to 59.3 % (70/118) ( p  < 0.05) when attempting to stent lesions of greater than 5 cm. There was also a significant reduction in clinical success when stenting lesions on a bend rather than a straight segment of colon 75.7 % (109/144) versus 59.7 % (74/124) ( p  < 0.05). A total of 20 (7.46 %) perforations were identified during the study. Stent migration occurred in 6.6 % of cases. In-stent stenosis occurred in 3.3 %. The overall 30-day all cause mortality rate was 9 %. Conclusion Lesion size, location and duration of obstructive symptoms are statistically significant determinants of patient outcome. These factors could be used to advise patient selection for colonic stenting or direct progression to surgical intervention.