title: Predictive factors for successful colonic stenting in acute large-bowel obstruction: a 15-year cohort analysis.
abstract: BACKGROUND
  Colonic stenting has failed to show an improvement in mortality rates in comparison with emergency surgery for acute large-bowel obstruction. However, it remains unclear which patients are more likely to benefit from this procedure.
  
  
  OBJECTIVE
  The aim of this study is to identify factors that may be predictive of successful outcome of colonic stenting in acute large-bowel obstruction.
  
  
  METHODS
  All patients undergoing colonic stenting for acute large-bowel obstruction between 1999 and 2013 were studied. The demographics and characteristics of the obstructing lesion were analyzed.
  
  
  METHODS
  This investigation was conducted at a district general hospital.
  
  
  METHODS
  A total of 126 (76 men; median age, 76 y; range, 42-94 y) with acute large-bowel obstruction were included in the analysis.
  
  
  METHODS
  The insertion of a self-expanding metal stent was attempted for each patient to relieve the obstruction.
  
  
  METHODS
  The primary outcomes measured were technical success in the deployment of the stent, clinical decompression, and perforation rates.
  
  
  RESULTS
  Technical deployment of the stent was accomplished in 108 of 126 (86%) patients; however, only 89 (70%) achieved clinical decompression. Successful deployment and clinical decompression was associated with colorectal cancer (p = 0.03), shorter strictures (p = 0.01), and wider angulation distal to the obstruction (p = 0.049). Perforation was associated with longer strictures (p = 0.03).
  
  
  CONCLUSIONS
  This study was limited by its retrospective nature.
  
  
  CONCLUSIONS
  Colonic stenting in acute large-bowel obstruction is more likely to be successful in shorter, malignant strictures with less angulation distal to the obstruction. Longer benign strictures are less likely to be successful and may be associated with an increased risk of perforation.
authors: 1 Department of Surgery, Barnet Hospital, Royal Free London NHS Foundation Trust, Barnet, United Kingdom 2 Department of Radiology, Barnet Hospital, Royal Free London NHS Foundation Trust, Barnet, United Kingdom.
authors: Derek J
authors: DJ
authors: Boyle
authors: Christopher
authors: C
authors: Thorn
authors: Ashish
authors: A
authors: Saini
authors: Colin
authors: C
authors: Elton
authors: Gary K
authors: GK
authors: Atkin
authors: Ian C
authors: IC
authors: Mitchell
authors: Kevin
authors: K
authors: Lotzof
authors: Adrian
authors: A
authors: Marcus
authors: Pawan
authors: P
authors: Mathur
mesh_terms: D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D003108:Colonic Diseases / Q000145:classification / Q000150:complications* / Q000473:pathology; D019299:Decompression, Surgical / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology; D007420:Intestine, Large / Q000293:injuries / Q000473:pathology / Q000601:surgery; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D020379:Risk Adjustment; D012307:Risk Factors; D015607:Stents; D006113:United Kingdom