Efficacy of uncovered self-expandable metallic stent for colorectal obstruction by extracolonic malignancy

BACKGROUND Self-expandable metallic stent(SEMS)is widely used for malignant colorectal obstruction.Recently,SEMS has been used for palliative option for colorectal obstruction caused by extracolonic malignancy(ECM).AIM To evaluate the efficacy of SEMS for colorectal obstruction caused by ECM,and to identify the factors associated with stent occlusion.METHODS Seventy-two patients who were treated with uncovered SEMS insertion for malignant colorectal obstructions caused by colorectal metastasis or peritoneal seeding of ECM at Samsung Medical Center between April 2012 to March 2016 were enrolled.We analyzed technical and clinical outcomes of stent insertion,the factors associated with stent occlusion and long term outcomes after stent insertion.RESULTS Technical success rate was determined as 90.3%with a clinical success rate of 87.7%.Stent occlusion developed in 28.1%,with a median duration of 51 d.Further,81.3%with stent occlusion could be treated with secondary stent insertion.Clinical failure was observed to be related to the male sex(P=0.020)and right colon obstruction(P=0.017).Stent length≤10 cm was found to be associated with stent occlusion(P=0.003).Median survival time after stent insertion was 4.7 mo and 40.4%were able to receive their oncological treatments after stent insertion without surgery.CONCLUSION Uncovered SEMS is effective for the treatment of colorectal obstruction caused by ECM,considering life expectancy of patients with ECM.

Clinical application of self-expanding metallic stent in the management of acute left-sided colorectal malignant obstruction

AIM： To summarize our experience with the application of self-expanding metallic stent （SEMS） in the management of acute left-sided colorectal malignant obstruction. METHODS： A retrospective chart review of all patients undergoing placement of SENS between April 2000 and January 2004 was performed. RESULTS： Insertion of SENS was attempted in 26 patients under fluoroscopic guidance with occasional endoscopic assistance. The sites of lesions were located in splenic flexure of two patients, left colon of seven patients, sigmoid colon of eight patients and rectum of nine patients. The intended uses of SENS were for palliation in 7 patients and as a bridge to elective surgery in 19 patients. In the latter group, placement of SENS allowed for preoperative systemic and bowel preparation and the following one-stage anastomosis. Successful stent placement was achieved in 22 （85%） of the 26 patients. The clinical bowel obstruction resolved 24 hours after successful stent placement in 21 （95%） patients. Three SENS-related minor complications occurred, two stents migrated and one caused anal pain. CONCLUSION： SEMS represents an effective and safe tool in the management of acute malignant colorectal obstruction. As a bridge to surgery, SEMS can provide time for systematic support and bowel preparation and obviate the need for fecal diversion or on-table lavage. As a palliative measure, SEMS can eliminate the need for emergent colostomy.

Colonic stent for bridge to surgery for acute left-sided malignant colonic obstruction:A review of the literature after 2020

It has been found that 8%-29%of colorectal cancers are obstructive.The use of“stent as bridge to surgery”is one of the most debated topics in obstructive leftsided colorectal cancer management.The endoscopic placement of a selfexpanding metallic stent as bridge to surgery(BTS)could turn an emergency surgery to an elective one,increasing the number of primary anastomoses instead of stoma and facilitating the laparoscopic approach instead of an open one.However,in recent years the possible risk of perforations and microperforations facilitating cancer spread related to the use of self-expanding metallic stent for BTS has been highlighted.Therefore,despite the useful short-term outcomes related to BTS,the recent literature has focused on long-term outcomes investigating the disease-free survival,the recurrence rate and the overall survival.Due to discordant data,international guidelines are still conflicting,and the debate is still open.There is not agreement about using self-expanding metallic stent for BTS as the gold standard.

Improving quality measures in colonoscopy and its therapeutic intervention

Colonoscopy with polypectomy has been shown to reduce the risk of colon cancer. The critical element in the quality of colonoscopy in terms of polyp detection and removal continues to be the performance of the endoscopist, independent of patient-related factors. Improved results in terms of polyp detection and complete removal have implications regarding the development of screening and surveillance intervals and the reduction of interval cancers after negative colonoscopy. Advances in colonoscopy techniques such as high-definition colonoscopy, hood-assisted colonoscopy and dye-based chromoendoscopy have improved the detection of small and flat-type colorectal polyps. Virtual chromoendoscopy has not proven to improve polyp detection but may be useful to predict polyp pathology. The majority of polyps can be removed endoscopically. Available polypectomy techniques include cold forceps polypectomy, cold snare polypectomy, conventional polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection. The preferred choice depends on the polyp size and characteristics. Other useful techniques include colonoscopic hemostasis for acute colonic diverticular bleeding, endoscopic decompression using colonoscopic stenting, and transanal tube placement for colorectal obstruction. Here we review the current knowledge concerning the improvement of quality measures in colonoscopy and colonoscopy-related therapeutic interventions.

Delayed ischemic gangrene change of distal limb despite optimal decompressed colostomy constructed in obstructedsigmoid colon cancer:A case report

Creating blow-hole colostomy for decompression could provide a time-saving and efficient surgical procedure for a severely debilitated case with a completely obstructed colorectal cancer. Complications are reported as prolapse, retraction, and paracolostomal abscess. However, complication with an ischemic distal limb has not been reported. We report a case of critical intra-abdominal disease after decompressed colostomy for relieving malignant sigmoid colon obstruction; a potential fatal condition should be alerted. A 76-year-old male visited our emergency department for symptoms related to obstructed sigmoid colon tumor with foul-odor vomitus containing fecal-like materials. An emergent blow-hole colostomy proximal to an obstructed sigmoid lesion was created, and resolution of complete colon obstruction was pursued. Unfortunately, extensive abdominal painful distention with board-like abdomen and sudden onset of high fever with leukocytopenia developed subsequently. Such surgical abdomen rendered a secondary laparotomy with resection of the sigmoid tumor along with an ischemic colon segment located proximally up to the previously created colostomy. Eventually, the patient had an uneventful postoperative hospital stay. In the present article, we have described an emergent condition of sudden onset of distal limb ischemia after blow-hole colostomy and concluded that despite the decompressed colostomy would resolve acute malignant colon obstruction efficiently; impending ischemic bowel may progress with a possible irreversible peritonitis. Any patient, who undergoes a decompressed colostomy without resection of the obstructed lesion, should be monitored with leukocyte count and abdominal condition survey frequently.