James Henry Briggs MBChB, FRCR, Abstract Co-Author: Nothing to Disclose

Thomas Oakley MBBS, MA, Presenter: Nothing to Disclose

Mark William Little MBBS, MSc, Abstract Co-Author: Nothing to Disclose

Joe Benson Woodhouse MBBS, Abstract Co-Author: Nothing to Disclose

Shaheen Dixon MBBS, FRCR, Abstract Co-Author: Nothing to Disclose

Charles Ross Tapping MBBCh, FRCR, Abstract Co-Author: Nothing to Disclose

Raman Uberoi MBChB, FRCR, Abstract Co-Author: Nothing to Disclose

The aims of this study are to determine anatomical and clinical factors which affect outcome following stenting for large bowel obstruction, allowing improved treatment selection for patients.

Retrospective review of all colonic stents placed in our institution between February 2006 and December 2013 was undertaken. This yielded 271 stents placed in 249 patients. Radiological and medical records were examined and a wide range of data collected, including patient demographics, nature, location and length of stricture, duration of symptoms, technical and clinical success, complication and 30 day mortality.

Technical and clinical success were 80.1% and 68.3% respectively. Clinical success was significantly lower in strictures longer than 5cm (53.4% vs 71.3%, p=0.0216). Clinical success was also lower in lesions at anatomical flexures (59.6% vs 75.6%, p=0.0096). A longer duration of symptoms (more than one week) was associated with lower technical success (69.2% vs 85.4%, p=0.0086). Overall complication rate was 27.1% (17.2% perforations, 6.6% stent migration and re-occlusion in 3.3%) and in line with other series. Analysis of the cases with perforation showed that only half of the perforations were related to stent placement. There was a non statistically significant trend toward incrased perforation rate in benign strictures over malignant ( 2.8% vs 11.1%, p=0.0602). No significant trends relating to patient age or 30 day mortality were shown. The length and site of stricture were not shown to be related to complication rate.

This study represents the largest published series of colonic stents to date. It has identified statistically significant trends in clinical success and lesion length and location, with lower technical success in patients with symptoms for longer than one week. These findings should be taken into account when choosing a treatment strategy for patients presenting with large bowel obstruction to optimise technical and clinical outcomes.

Limited quality evidence exists around colonic stenting for bowel obstruction. The current study represents that largest single cohort of patients undergoing stenting for large bowel obstruction to date. We have identified patient, clinical and anatomical factors to stratify risk and predict outcomes. We present new evidence to refine decision making in relation to the management of colonic obstruction.

Briggs, J, Oakley, T, Little, M, Woodhouse, J, Dixon, S, Tapping, C, Uberoi, R, Technical and Clinical Outcomes of Colorectal Stenting in Large Bowel Obstruction.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013402.html