251 Use of Self-expanding Metal Stents (SEMS) in Emergency Colonic Obstruction (a retrospective study)
A Makhort, M Fouad- Surgery
Abstract
Aim
Colorectal cancer is becoming increasingly common in UK, presenting as an emergency in 20% of cases. This carries significantly higher (six-fold) mortality compared with an elective presentation. There is high level evidence that self-expanding metal stents (SEMS) can be successfully used both for palliation (as a definitive procedure) and as a bridge to surgery (BTS) in patients with colorectal cancer. ACPGBI consensus guidelines in emergency general surgery suggest expected success rate of 90% whilst requesting units to audit their figures to evaluate success rates and complications.
Method
We performed a retrospective audit of SEMS placement over nearly 5-year period in our colorectal unit (spanning from July 2016 to May 2021). We accessed local reporting systems and electronic patient notes for pathology, site, results and outcome post attempted stenting.
Results
Total number of SEMS inserted = 30. One patient was excluded due to incomplete data present. Male:female ratio = 1.5:1. Mean age at application = 71.5 (range 37-96). Most common site was sigmoid (48%), followed by descending colon (28%). Success rate was 86%. Majority of SEMS were used as a palliative procedure - 86% vs 10% as BTS. 10% of patients had complications following stent insertion, including blockage and leak, in all cases leading to emergency Hartmann’s procedure.
Conclusions
Data shows significant SEMS use locally particularly for palliation. Success rates are comparable with national and show stenting can be performed by an experienced radiologist. However, complication risks are not insignificant, and patients should be counselled accordingly prior to procedure.