title: Self-expanding metallic stents for large bowel obstruction.
abstract: BACKGROUND
  Self-expanding metallic stents (SEMS) may relieve colonic obstruction as definitive therapy or as a bridge to elective surgery.
  
  
  METHODS
  This was a retrospective longitudinal cohort study of patients undergoing insertion of SEMS for large bowel obstruction at one institution. Scrutiny of the radiology department's coding system allowed identification of all patients undergoing colonic stent insertion between 2002 and 2008. Data were extracted from patient case notes and investigation reports.
  
  
  RESULTS
  Eighty-two patients with a median age of 75 (interquartile range (i.q.r.) 43-94) years underwent stent insertion, 71 for palliation and 11 as a bridge to surgery. Obstruction was due to malignant disease in 67 patients and had a benign cause in 15. Median survival in the palliative setting was 103 (i.q.r. 44-317) days. Complications occurred in 43 patients, of whom 22 underwent unplanned surgery. High-grade obstruction (relative risk (RR) 2·05; P = 0·055) and benign disease (RR 3·45; P < 0·001) were associated with risk of adverse events.
  
  
  CONCLUSIONS
  SEMS should not be used for large bowel obstruction with benign pathology.
authors.affiliation: Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK. cmackay@doctors.org.uk
authors.forename: C D
authors.initials: CD
authors.lastname: Mackay
authors.forename: W
authors.initials: W
authors.lastname: Craig
authors.forename: J K
authors.initials: JK
authors.lastname: Hussey
authors.forename: M A
authors.initials: MA
authors.lastname: Loudon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000209:etiology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000209:etiology / Q000401:mortality; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome