Outcomes after stenting for malignant large bowel obstruction without radiologist support

AIM:To assess outcomes after colonic stent insertion for obstructing colorectal malignancies performed by an endoscopist without radiologist support.METHODS:This is a retrospective study of all stents inserted by a single surgeon in a District General Hospital over an eight year period.All stents were inserted for patients with acute large bowel obstruction secondary to a malignant colorectal pathology either for palliation or as a bridge to surgery.Procedures were performed by a single surgeon endoscopically with fluoroscopic control in the X-ray department but withoutthe support of an interventional radiologist.Data was collected prospectively on a pre-designed database.RESULTS:The indication for all stent procedures was an obstructing colorectal malignancy.Out of 53patients,the overall success rate was 90.6%.Eight patients had a stent intended as a bridge to surgery and 45 as a palliative procedure.Technical success was achieved in 50 out of 53 procedures(94.3%)and clinical success in 48 of those remaining 50(96.0%).Those with unsuccessful technical or clinical procedures went on to have defunctioning stomas to treat their obstruction.There were six complications from the technically successful stents(12.0%).These included one migration,one persisting obstructive symptoms and four cases of tumour overgrowth of the stents at a later date.Haemorrhagic complications,perforation or mortality were not observed in our series.Our results are comparable to several other studies assessing stent outcomes for obstructing bowel cancer.CONCLUSION:Our data suggests that colorectal stents can be inserted without radiologist support by an adequately trained individual with good outcomes.