Technical and Clinical Outcomes Following Colonic Stenting: A Seven-Year Analysis of 268 Procedures.
OBJECTIVE
To assess the factors contributing to the technical and clinical success of colorectal stenting for large bowel obstruction.


METHODS
268 cases of colonic stenting for large bowel obstruction were performed in 249 patients of mean age of 72 years (28-98) between 2006 and 2013. The majority of strictures were due to malignant disease, 244/268 (91 %). Diverticular strictures accounted for 24/268 (9 %).


RESULTS
Overall technical success rate was 81 % (217/268), with a clinical success rate of 65 % (174/268). Duration of symptoms ranged from 0 to 180 days (mean 8 days). Technical success rate was seen to decrease with increasing symptom duration. For symptom duration of less than 1 week, technical success was 85.4 % (181/212) versus 69.6 % (39/56) for those with symptoms of greater than a week (p < 0.05). Clinical success rates fell from 71.3 % (107/150) to 59.3 % (70/118) (p < 0.05) when attempting to stent lesions of greater than 5 cm. There was also a significant reduction in clinical success when stenting lesions on a bend rather than a straight segment of colon 75.7 % (109/144) versus 59.7 % (74/124) (p < 0.05). A total of 20 (7.46 %) perforations were identified during the study. Stent migration occurred in 6.6 % of cases. In-stent stenosis occurred in 3.3 %. The overall 30-day all cause mortality rate was 9 %.


CONCLUSIONS
Lesion size, location and duration of obstructive symptoms are statistically significant determinants of patient outcome. These factors could be used to advise patient selection for colonic stenting or direct progression to surgical intervention.
Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK.
M W
MW
Little
Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK.
T
T
Oakley
Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK.
J H
JH
Briggs
Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK.
J A
JA
Sutcliffe
Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK.
A K
AK
Allouni
Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK.
G
G
Makris
Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK.
M J
MJ
Bratby
Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK.
C R
CR
Tapping
Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK.
R
R
Patel
Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK.
A
A
Wigham
Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK.
S
S
Anthony
Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK.
J
J
Phillips-Hughes
Department of Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK. Raman.uberoi@ouh.nhs.uk.
R
R
Uberoi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000628:therapy*; D043963:Diverticulosis, Colonic / Q000628:therapy*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome