SJLA_2024_A12: Clinical Outcomes of Endoscopic Stent in Curative and Palliative Management of Malignant Colonic Obstruction: A Retrospective Cohort Study
Authors: Alhassan Noura , Helmi Hadeel , Alzamil Abdulrahman , Batais Salman , Alkhayyal Yazeed , Alshammari Sulaiman , Altuwaijri Mansour , AlShankiti Suliman , Alotaibi Ammar , Bin Traiki Thamer 
Published: September 2024

Background:
Malignant colonic obstruction (MCO) occurs in 10%–18% of colorectal cancers. Conventionally, emergency surgery has been the standard treatment modality. However, it is associated with higher morbidity and mortality rates compared to patients undergoing elective surgery. With the advancement of endoscopic techniques, self-expandable metal stent has been advocated as an alternative management. It provides relief of obstructive symptoms, allowing the patient’s general condition to be restored and enabling elective surgery. Furthermore, the ability to complete staging allowed identification and avoidance of unnecessary surgery in patients with advanced disease who need palliative measures. However, various stent-related complications.
have been reported in the literature, including perforation (4.5%), migration (11%), and obstruction (12%).

Aim:
This study aimed to evaluate the technical and clinical success rates and the complication rate of stent placement in patients with MCO. In addition, we compared the rates of laparoscopic surgery, stoma creation, and postoperative outcomes between different subgroups.

Methods:
We conducted a retrospective cohort study including all patients diagnosed with MCO between March 2015 and September 2021. Patients were divided into groups according to the initial treatment they received, stent versus surgery, and the intent of treatment, and curative versus palliative. Data were collected from medical records.

Results:
Among 112 patients, 24 had stenting as a bridge to surgery, and 16 underwent palliative stenting. The technical and clinical success rates were 95% and 94.7%, respectively. Stent placement failed in two patients in the curative group due to complete obstruction with the inability to pass the guidewire in one patient and perforation in the other. Clinical failure was encountered in two patients who had persistent symptomatic obstruction beyond 48 h from stenting. The early complication rate following stent insertion was 7.5%. Among curative patients, stenting did not affect surgical resection in terms of laparoscopic approach or need for stoma creation. However, it was associated with longer hospital stay. On long-term follow-up, half the patients who received stent in the palliative group required re-intervention due to re-obstruction with either re-stenting or surgery. The mean stent patency time was 7 months.

Conclusion:
Management of MCO varies based on the patients’ clinical presentation, tumor site, and surgeon’s preference. Stent placement is an effective and safe management option for selected patients with MCO with reasonable clinical and technical success rates. Complication rates are low, particularly when used as a bridge to surgery. However, long-term patency and the need for re-intervention are an area of concern among palliative patients.