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Colonic Stenting in Mid-Yorkshire Hospitals NHS Trust: Are we doing it appropriately?
Poster Title: Colonic Stenting in Mid-Yorkshire Hospitals NHS Trust: Are we doing it appropriately?
Submitted on 20 Sep 2019
Author(s): Claire Ryan; Stuart Kerr
Affiliations: Mid-Yorkshire Hospitals NHS Trust
Poster Views: 80
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Poster Information
Abstract: Background: Colorectal cancer was the 3rd most diagnosed cancer worldwide in 2018 (1.8M cases)[1]. Large bowel obstruction (LBO) has been shown to occur in around 8% of stage IV colon cancers[2]. The treatment approach of acute LBO remains controversial - whether by self-expandable metallic stents or surgical intervention[3]. The European Society of Gastrointestinal Endoscopy (ESGE) and National Institute for Health and Care Excellence (NICE) have guidelines[4,5] regarding colonic stents: generally, their indication is for palliative treatment of malignant left-sided LBO.

Aims: To investigate whether we, at Mid-Yorkshire Hospitals, are stenting appropriate patients, observe our complication rate and review our survival data.

Methods: We undertook a retrospective analysis, gathering data from all patients stented between January 2014 - December 2018, using the trust's colonic stent database (populated by the radiologists performing these procedures) and the Radiology Information System (CRIS).

Results: There were 118 patients (142 procedures: 15% had repeat stents); age range: 39-92; 46 females, 72 males. 84% of patients were palliative. Of all procedures, 64 were for acute LBO and 78 were elective (outpatient or ‘prophylactic’; 45% v 55%). 21% led to an early complication (within 2 weeks) and 25% resulted in a late complication. Median survival was approximately 9 months.

Conclusions: It appears most patients are appropriately selected for colonic stenting, with complication rates comparable with published studies. Stenting should only be performed in patients with evidence of obstruction and not as a prophylactic procedure. Stenting as a “bridge to surgery” in non-palliative patients is controversial, in light of the adverse oncological implications of iatrogenic perforation.
Summary: Colonic Stenting in Mid-Yorkshire Hospitals NHS Trust: Are We Doing it Appropriately?References: 1. Bray F, Ferlay J et al Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68(6): 394-424
2. Winner M, Mooney SJ, Hershman DL et al. Incidence and predictors of bowel obstruction in elderly patients with stage IV colon cancer: a population-based cohort study. JAMA Surg 2013; 148: 715–722
3. Hill J et al Randomised phase III study of stenting as a bridge to surgery in obstructing colorectal cancer-Results of the UK ColoRectal Endoscopic Stenting Trial (CREST). J CLIN ONCOL 2016; 34(15): 3507-3507
4. van Hooft Jeanin E et al. SEMSs for obstructing colonic and extracolonic cancer: ESGE Clinical Guidelines. Endoscopy 2014; 46: 990-1002
5. NICE Evidence review. CG131 Colorectal cancer: the diagnosis and management of colorectal cancer. Ch 3.2 Colonic Stents. 2011: 230-238.
6. Iverson, et al Self-expanding metallic stents as a bridge to surgery in obstructing colorectal cancer. B
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