Colonicstentingversusemergency surgery for acute leftsided. Tu1527 colonic stents as bridge to elective surgery versus. Rcts comparing colonic sems versus surgery for malignant large bowel obstruction in palliative patients were included. Baron, 2 allesandro repici, 3 linda jo taylor, 4 and douglas. As the patients were complicated with obstruction, intestinal cleaning had to be completed using a lowpressure enema. C9 effectiveness of stenting for acute large bowel. Preoperative colonic stents vs emergency surgery for acute leftsided. In the bridge to surgery group, stent placement is an option to improve clinical conditions and decrease bowel dilatation before elective surgery. Full text selfexpanding metallic stent as a bridge to. Background acute colonic obstruction because of advanced colonic malignancy is a surgical emergency aim to compare the clinical outcomes and cost.
Pdf colonic stenting versus emergency surgery for acute. Colonic stenting with elective surgery versus emergency. Gastroenterology, gastroenterology and gut by manual. Randomized trial of colonic stents as a bridge to surgery. Colonic stent versus emergency surgery as treatment of malignant. Usually involves bringing the bowel to the skin and a stoma a bag on the skin into which the bowel empties. The alternative to colonic stenting is an operation. Effectiveness and safety of metallic stent for ileocecal. Pdf emergency preoperative stenting versus surgery for acute left. Malignant colonic occlusion is traditionally considered a surgical emergency. Pdf emergency preoperative stenting versus surgery for. Metaanalysis of complications of colonic stenting versus. The clinical use of sbts has been mainly suggested in advanced or non resectable tumors, in order to avoid the need for emergency surgery, thus obtaining a good palliation and, at the same time, delaying.
What is the role of colonic stents in the treatment of. This multicenter randomized study will compare those two strategies with regard to effectiveness and costs. The use of colorectal stents for palliative or preoperative bridge therapy has low morbidity. Emergency endoscopic colonic stenting followed by elective surgery at a later date for acute leftsided malignant colonic obstruction. Colonic stent utilization characteristics, poststent insertion health outcomes, and health care encounters were. Based on the current evidence, this article will provide a practical update on the indications, the clinical and technical. Colonic stenting as bridge to surgery versus emergency. Patients with acute leftsided malignant colonic obstruction eligible for this study will be randomized to either emergency surgery current standard treatment or colonic stenting as bridge to elective surgery. The objective of the study was to determine stent utilization for crc obstruction in the province of ontario between april 1, 2000, and march 30, 2009. Colonic stents for colorectal cancer are seldom used and. Endoscopic stenting as bridge to surgery versus emergency. The use of colonic stents as a bridge to surgery has the potential to 14 convert a bowel obstruction from an emergency condition to an elective situation, yet. The clinical success rate was statistically higher in emergency surgery group.
Surgical decompression with colostomy with or without resection and eventual. Selfexpandable metal stent as a bridge to surgery for. With the development of endoscopic techniques, metallic stents have emerged to ensure the colonic patency in nonsurgical candidates and, more recently, as a. Colonic stenting with elective surgery versus emergency surgery in the management of acute malignant colonic obstruction the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Numerous randomized controlled trials were conducted comparing the use of sems as a bridge to surgery versus emergency surgery for the management of acute malignant large bowel obstruction 1117. In patients aged 75 years or less, stenting and delayed surgery was associated with a higher local recurrence rate compared with emergency surgery at the end of. Selfexpandable stents for obstructing colorectal cancer crc offer an alternative to operative management. We present 4 cases of successful bridgetosurgery stenting for ileocecal cancer. Advances have led to less invasive procedures such as stenting as a bridge for definitive surgery. Colonic endoscopic stenting is safe and effective in the management of malignant colorectal obstruction for palliative care or bridge to a surgery, with a low complication rate 22,2%. However, there are issues about availability and expertise within the uk, and controversies remain regarding various clinical and technical aspects of the technique.
Emergency preoperative stenting versus surgery for acute leftsided malignant colonic obstruction. Preoperative colonic stents vs emergency surgery for acute left. In the past, emergency surgery has been the primary treatment for mco. The chart showing pdf series, word series, html series, scan qr codes. Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting. Endoscopic stenting in colorectal cancer home journal of. The use of colonic stent in malignant colorectal obstruction seems to have no advantage over emergency surgery. Recently, selfexpandable metallic stents sems have been used as a bridge to surgery in an attempt to decompress the colon and then allow elective onestage surgical resection without stoma. However, use of colorectal stents seems to be as safe in the malignant colorectal obstruction as the emergency surgery with no statistically significant difference in. The purpose of this paper is to evaluate the efficacy and safety of colonic stenting as a bridge to surgery versus emergency surgery for acute leftsided malignant colonic obstruction.
Yan, 1 daniel brandt, 1 raymond janowski, 1 ankush kalra, 1 tingting zhan, 1 todd h. Martinezsantos c, lobato rf, fradejas jm, pinto i, ortegadeballon p, morenoazcoita m. We aimed to establish whether colonic stenting has better. Preoperative colonic stents versus emergency surgery for acute. Rcts comparing sems as a bridge to surgery versus emergency surgery in patients with leftsided malignant obstruction report ed benign. The rationale for such a move is to provide swift and effective decompression of the. The aim was to compare morbidity rates after colonic stenting bridge to surgery sbts versus emergency surgery es for leftsided malignant obstruction.
Longterm outcomes of palliative colonic stenting versus. Purpose emergency surgery is a traditional treatment option for patients with malignant left sided colonic obstruction which involves defunctioning stoma with or without primary anastomosis. Its use has not been recommended in acute suspected malignant colonic obstruction as a bridge to surgery due to. Oncological outcome of malignant colonic obstruction in the. Pooled analysis of the efficacy and safety of selfexpanding metal stenting in malignant colorectal. Colonic stent versus surgery for the management of acute. Sometimes, the colonic stenting procedure is followed by an operation. Preoperative colonic stents vs emergency surgery for acute. Acute colonic obstruction because of malignancy is often a surgical emergency. The aim of colonic stenting with selfexpandable metallic stents in neoplastic colon obstruction is to avoid emergency surgery and thus potentially reduce morbidity, mortality, and need for a stoma. Pdf preoperative colonic stents versus emergency surgery. Bts bridge to surgery, e surgery emergency surgery, mh mantelhaenszel, 95 % ci 95 % con. With respect to mortality, findings of a randomised trial 26 and several comparative nonrandomised or matched controlled studies did not show a significant difference between colonic stenting and emergency surgery,4, 5, 6, 12 with the exception of a study by park and colleagues.
Randomized clinical trials rct that compared the efficacy or safety of preoperative colonic stents versus emergency surgery for acute leftsided malignant colonic obstruction were searched in medical databases. Colonic stent versus emergency surgery as treatment of. Unsuccessful stenting required emergency surgery in six patients owing to wire or stent perforation. Background colonic stenting as a bridge to elective surgery is an alternative for emergency surgery in patients with acute malignant colonic obstruction, but its bene. Preoperative colonic stents versus emergency surgery for. Colonic stenting versus emergency surgery for acute left. Rcts comparing sems as a bridge to surgery versus emergency surgery in patients with leftsided malignant obstruction reported benign obstructive lesions in 4. Experience with endoluminal colonic wall stents for the.
Between march 9, 2007, and aug 27, 2009, 98 patients were assigned to receive colonic stenting n47 patients or emergency surgery n51. Acute leftsided colonic obstruction is most often caused by malignancy and the surgical treatment is associated with a high mortality and morbidity rate. We believe that endoscopic colonic stenting is safe, effective, and lasting, and should be considered as initial nonoperative management in all patients seen with lbo in the absence of peritonitis. They analyzed medline, embase and the cochrane library in order to evaluate the complications of.
Stent as bridge to surgery for leftsided malignant. Stenting as a bridge to resection versus emergency surgery. Colonic stenting as a bridge to elective surgery has been proposed as an alternative to emergency surgery. These benign colonic lesions that mimic malignancy are usually due to diverticular disease.
Leftsided malignant colonic obstruction is one of the most difficult clinical problems, whereas both emergency operations and colonic stenting may have their own advantages and disadvantages. Colonic stenting versus emergency surgery for acute leftsided. For this reason, the stentin 2 study is conceived to compare colonic stenting as bridge to elective surgery with emergency surgery current standard treatment for the management of acute leftsided malignant colonic obstruction. Role of colonic stents in the management of colorectal cancers. Stenting as a bridge to surgery sbts is a relatively novel procedure, potentially useful to treat symptomatic leftsided malignant colonic obstruction. In the endoscopy unit, stent placement was performed by two experienced endoscopists using a coloscope cfh260ai, olympus, tokyo, japan with fluoroscopic guidance. Colonic stenting has no decisive advantages to emergency. We compared morbidity rates after colonic stenting as a bridge to surgery. How to decide on stent insertion or surgery in colorectal.
Conclusions urgent surgery with colostomy for lbo was avoided in 10 of 11 patients because of successful placement of ecwss. Colonic stenting versus emergency surgery for acute leftsided malignant colonic obstruction. In the metaanalysis, by comparing colonic stenting cs as bridge to surgery and emergency surgery, the pooled analysis showed no significant difference between the two techniques in terms of mortality odds ratio or 0. Compared with the emergency surgery group, the colonic stent group achieved significantly more. Approximately 829% of patients with crc exhibit symptoms of a malignant obstruction at the time of diagnosis, and approximately 75% of colon obstructions occur in the left side of the colon. Patients who had successful stenting were discharged and readmitted for elective surgery. Surgical management of left colonic cancer presenting as an acute obstruction remains controversial and still is associated with high mortality and morbidity rates.
Comparison of longterm outcomes of colonic stent as. Endoscopic colonic stenting has been recognized as a. The purpose of this study was to evaluate the complications of colonic stenting versus emergency surgery for acute leftsided malignant colonic obstruction. Emergency surgery is the conventional treatment in these. Colorectal cancer crc is a common malignancy of gastrointestinal system that has a high incidence rate. Initial insertion of an enteral stent to decompress the obstructed colon, allowing for surgery to be performed electively, is gaining popularity.
Patients in whom stenting was unsuccessful underwent emergency surgery. Longterm outcomes of palliative colonic stenting versus emergency surgery for acute proximal malignant colonic obstruction. Colonic stenting as bridge to surgery versus emergency surgery for management of acute leftsided malignant colonic obstruction. Colonic stenting is part of the uk service provision guidelines for colorectal cancer. Concern has been raised, however, about the effect of colonic stenting on shortterm complications and longterm survival. Selfexpandable metal stents for obstructing colonic and.
Colonic stenting as a bridge to surgery versus emergency. Emergency preoperative stenting versus surgery for acute. Two successive interim analyses showed increased 30day morbidity in the colonic stenting group, with an absolute risk increase of 019 95% ci. The patient should speak to the team looking after them to discuss potential options. Pdf surgical management of left colonic cancer presenting as an acute obstruction remains controversial and still is associated with high mortality. Abstract background colonic obstruction is a surgical emergency, and delay in decompression results in added morbidity and mortality. Hartmanns procedure vs loop colostomy in the treatment of. Its use has not been recommended in acute suspected malignant colonic obstruction as a bridge to surgery due to evidence of its impact on. Using an endoscopic retrograde cholangiopancreatography catheter with a movable tip and a decompression tube was effective. Local recurrence after stenting for obstructing left.
1378 1294 927 869 393 1575 1520 1122 37 1586 1619 195 1095 1255 298 1142 298 419 953 1501 143 943 793 1213 336 680 495 41 770 353 1438 1005 507 474 1136 721 733