title: Stenting for Emergency Colorectal Obstruction: An Analysis of 204 Patients in Relation to Predictors of Failure and Complications.
abstract: OBJECTIVE
  Self-expanding metallic stents are increasingly used in the management of malignant and benign colorectal obstructions. We aimed to identify relevant predictive factors for stent failure and stent-related complications.
  
  
  METHODS
  We conducted a retrospective single-center analysis of 204 consecutive patients who underwent emergency colorectal stenting procedures because of symptomatic bowel obstructions from 1996 to 2011 at the Sisters of Charity Hospital Linz, Austria.
  
  
  RESULTS
  A total of 204 patients (median age 74 years) with 36 (17.7%) benign and 168 (82.3%) malignant obstructions were included in the study. Technical success was achieved in 92.5% and clinical success in 86.8% of the cases. Major complications occurred in 2.9% and minor ones in 19.6%. Overall mortality during a median follow-up period of 4.3 years was 73% (149 patients). Relevant predictors of increased risk of complications were extracolonic obstruction (p = 0.001), complete obstruction (p = 0.066), and inflammatory bowel disease (p = 0.05). Stent localization at the splenic flexure, a stenosis of >8 cm in length, and the need for endoscopic guidance were associated with higher rates of technical and/or clinical stenting failure.
  
  
  CONCLUSIONS
  Colorectal stenting is less invasive than other means of emergency treatment for large bowel obstruction; it is generally safe and effective in different types of colorectal obstruction. However, relevant rates of failure and complications were recorded and predictors could be determined.
authors.affiliation: Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria Academic Teaching Hospital of the Universities Graz and Innsbruck, Linz, Austria gernot.koehler@bhs.at.
authors.forename: G
authors.initials: G
authors.lastname: Köhler
authors.affiliation: Center for Minimally Invasive Surgery, Hospital Neuwerk, Moenchengladbach, Germany.
authors.forename: S A
authors.initials: SA
authors.lastname: Antoniou
authors.affiliation: Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Lechner
authors.affiliation: Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: F
authors.initials: F
authors.lastname: Mayer
authors.affiliation: Department of Diagnostic and Interventional Radiology, Sisters of Charity Hospital, Linz, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Mair
authors.affiliation: Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria Academic Teaching Hospital of the Universities Graz and Innsbruck, Linz, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Emmanuel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D015179:Colorectal Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D012307:Risk Factors; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects*; D017211:Treatment Failure
keywords: Self-expanding metallic stents; bridge to surgery; colorectal cancer obstruction; large bowel obstruction; malignant colonic obstruction