IDDF2019-ABS-0216 Clinical Outcomes after Placement of Colonic Metallic Stents in Patients with Large Bowel Obstruction

Background Placement of colonic metallic stents (CMS) for malignant large bowel obstruction either as a bridge to surgery (BTS) or best supportive care (BSC) has been covered by national health insurance since 2012 in Japan. When possible, CMS is often considered a preferable intervention in cases deemed unsuitable for surgical resection. In this retrospective study, we report our experience with CMS, focusing on the improvement in oral intake levels. Methods 20 patients (13 men and 7 women) who developed large bowel obstruction and received CMS placements at our hospital from 2014 to 2019 were included for analysis. Baseline characteristics such as age, gender, type of obstruction and tumor location were reviewed. Intervention success rate was defined as having a ColoRectal obstruction scoring system (CROSS) level of 4 after CMS placement. Results Patient’s average age was 74 (53 to 101) years old. Cause of bowel obstruction were malignancies in 19 patients and benign inflammation (diverticulitis) in one patient. Tumor (or obstruction) was located in the transverse colon in 3 patients (15%), descending colon in 4 patients (20%), sigmoid colon in 6 patients (30%) and rectum in 7 patients (35%). Intervention success rate was 90% (18/20). Length of CMS used was 60mm in 5 patients, 80mm in 8 patients, 100mm in 4 patients and 120mm in 4 patients. One patient required double stenting (stent in stent) due to insufficient bowel dilation after initial CMS placement. The aim of CMS was BTS in 14 patients and BSC in 6 patients. The mean CROSS level was 2.9 prior to stenting and 3.7 (including intervention failures) after stenting. The average survival after CMS placement in BSC patients was 122 (4 to 360) days. In BTS patients, the average time to surgery was 23 (16 to 42) days. Conclusions Placement of CMS is an effective method to alleviate large bowel obstruction and avoid emergency decompression surgery. When the intervention is successful, CMS can improve oral intake and is a feasible option in patients unable to undergo surgery due to various risk factors, including old age.