title: Community experience of colonic stenting in patients with acute large bowel obstructions.
abstract: BACKGROUND
  Self-expandable metal stents (SEMS) can provide temporary relief of acute large bowel obstructions. Placement of SEMS creates the opportunity for semi-elective 1-stage surgical resections, use of possible adjuvant therapy or palliative relief of malignant obstructions. Our aim was to assess the likelihood of success and possible complication rates of SEMS insertion in a community hospital setting in patients presenting with large bowel obstructions.
  
  
  METHODS
  We conducted a retrospective chart review at a single community-based hospital. This review addressed the technical success in deployment of the SEMS, clinical success defined by relief of the obstruction, procedure-related complications, surgical interventions and completion of adjuvant therapy for patients with large bowel obstructions.
  
  
  RESULTS
  In a 34-month period, 16 patients underwent 16 SEMS procedures. The average age of patients was 69.4 years and 7 (44%) were women. Thirteen patients had intrinsic colorectal cancers, 1 had an extracolonic lesion (ovarian cancer) and 2 had strictures due to diverticular disease. Technical success occurred in all 16 patients, but only 15 (94%) had clinical success. No procedure-related deaths (defined as death within 7 days) occurred. Palliative stenting occurred in 5 patients (31%). Eleven patients (69%) eventually had surgery. Stenting allowed a window for neoadjuvant therapy in 4 patients. Ten of 11 patients (91%) had a 1-stage procedure. One patient had a cecal perforation presenting 2 days after SEMS. This patient received a defunctioning ileostomy.
  
  
  CONCLUSIONS
  In appropriate patients with large bowel obstructions, SEMS proced ures can be safely and effectively performed in a community-based setting.
authors.affiliation: Oakville Trafalgar Memorial Hospital and the Oakville Endoscopy Centre, Oakville, Ont. naveen_arya@hotmail.com
authors.forename: Naveen
authors.initials: N
authors.lastname: Arya
authors.forename: Douglas
authors.initials: D
authors.lastname: Bair
authors.forename: Praag
authors.initials: P
authors.lastname: Arya
authors.forename: Joe
authors.initials: J
authors.lastname: Pham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003108:Colonic Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications; D015607:Stents; D016896:Treatment Outcome