Sarah Eljamel MBChB, Presenter: Nothing to Disclose

Derek AJ Smith MBChB, Abstract Co-Author: Nothing to Disclose

Domenyk Brown MBBCh, Abstract Co-Author: Nothing to Disclose

Hugh M. Paterson, Abstract Co-Author: Nothing to Disclose

To determine the success rate of colonic stenting (CS) and describe positive/negative factors predictive of successful deployment. To determine the complication rate of colonic stenting and describe these encountered in the early and late phase. To define the average survival and stent patency/intervention free period in patients with inoperable metastatic disease (M1) and determine when palliative surgery may be preferable to CS.

All patients undergoing CS between November 2007 and October 2013 were identified from the departmental radiology electronic database. Clinical data was obtained from retrospective casenote review.

178 colonic stents were deployed in 165 patients. 143 patients had primary colonic malignancy, 102 of these had M1 disease at presentation. 41 patients were considered unfit for surgery or refused surgical intervention. Technical success rate was 81.6%. Univariate factors predictive of success were: position of obstruction (left/right) (p-value <0.01), degree of obstruction (complete obstruction/stricture) (p-value 0.09) and presentation type (elective/emergency) (p-value 0.49). Early complications (within 7 days): perforation (1.8%), stent migration (1.2%) and technical failure (1.8%). Late complications (within follow-up period): perforation (5.6%) and stent migration (3.6%) 17 patients represented with obstruction secondary to tumour ingrowth (10.3%). 8 were managed by further stenting (100% technical success). 2 had laser therapy to unblock stent. 7 underwent surgery. Median primary stent patency (to first intervention) is 558 days by Kaplan-Meier survival analysis. In M1 and M1 chemotherapy, estimated median primary stent patency is 555 days and 315 days respectively with a median patient survival of 139 days and 224 days.

CS is proven to be a viable option in the relief of colorectal obstruction. Ideal candidates have metastatic colorectal disease with a left colonic stricture. In patients with inoperable metastatic colorectal cancer; stenting provides effective, minimally invasive, long-term management in the palliation of colonic obstruction, with stent patency rates often exceeding patient survival.

CS is a viable management option in metastatic colorectal obstruction, but in patients fit enough to undergo chemotherapy and thus palliative surgery, when should surgery be offered over CS?

Eljamel, S, Smith, D, Brown, D, Paterson, H, When to Stent? Colonic Stenting – A Six Year Retrospective Review.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006793.html