Self-expandable Metallic Stent (SEMS) as an Alternative Utility to Resolve Left Side Colonic Obstruction

Purpose. Emergent surgery for acute colonic malignant obstruction is associated with high morbidity. Self-expandable metallic stents (SEMS) to relieve obstructions for bridge to surgery (BTS) or palliation have been increasingly used. We conducted a retrospective analysis of the short-term outcomes of SEMS in our hospital. Materials and Methods. We reviewed the records of patients who received SEMS in our hospital. A standardized procedure combining colonoscopy under fluoroscopic guidance was performed. The stent success rate and complications were analyzed. Results. From November 2016 to December 2017, fifteen patients underwent SEMS for relieving left-sided colonic obstruction. Seven for BTS (46.7%) and eight for palliation (53.3%). Success was achieved for all BTS group patients, but three patients had anastomosis leakage after subsequent elective laparoscopic surgery. In the palliative group, two (25%) had perforation and one (12.5%) had stent migration. Conclusion. Our initial experience demonstrated that SEMS was a feasible option to relieve acute colonic obstruction for both BTS and palliation. A larger study to assess long-term results is needed.

關鍵字

Colonic obstruction ； SEMS ； Bridge to surgery ； Palliation

並列摘要

目的：面對由於腫瘤造成的急性大腸阻塞，緊急手術往往造成較多的併發症。以大腸支架來緩解阻塞症狀，已經越來越被廣泛的使用。大腸支架可以做為橋接至根治性手術的過渡手段或是緩和治療。本研究將回溯性的分析本院置放大腸支架之成果。方法：本研究分析了在本院接受大腸支架放置的病人。透過大腸鏡以及X光透視下的合併運用，所有病人都接受一致的支架放置流程。我們進一步分析了支架放置成功率以及相關併發症。結果：自2016年11月至2017年12月，共15位病人因為左側大腸阻塞而接受支架放置。7位病人作為過渡至手術的目的，8位病人作為緩和治療目的。在過渡至手術組的支架放置成功率是100%，但後續3位病人在接受腹腔鏡結腸切除手術後產生了吻合處滲漏情形。在緩和組中，2位病人因支架置放而合併大腸破裂（25%），1位病人有支架位移的併發症（12.5%）。結論：本院的初步經驗顯示，大腸支架的放置在對於緩解腫瘤造成的急性阻塞上，是一個可行的治療選項。未來需要更大型的長期研究來評估成效。

並列關鍵字

結腸阻塞；金屬自動撐開支架；過渡至手術；緩和治療

參考文獻

A. Bonin et al. Update on the Indications and Use of Colonic Stents, Curr Gastroenterol Rep (2010) 12:374–382

Sagar J et al. Role of colonic stents in the management of colorectal cancers World J Gastrointest Endosc 2016 February 25; 8(4): 198-204

R. Cirocchi et al. Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: A systematic review and meta-analysis Surgical Oncology 22 (2013) 14-21

L. Gianotti et al. A prospective evaluation of short-term and long-term results from colonic stenting for palliation or as a bridge to elective operation versus immediate surgery for large-bowel obstruction; Surg Endosc (2013) 27:832–842

H Shimizu et al. Feasibility of laparoscopic surgery after stent insertion for obstructive colorectal cancer; Asian J Endosc Surg (2017)

國際替代計量

Self-expandable Metallic Stent (SEMS) as an Alternative Utility to Resolve Left Side Colonic Obstruction

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