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    Colonic Self Expanding Metallic Stents (SEMS) Indications & Contraindications

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    samer falcon
    1) Colonic self-expanding metallic stents were introduced over 17 years ago to relieve malignant colonic obstructions as an alternative to emergency surgery or colostomy. 2) Studies show stenting has high rates of technical (92%) and clinical (88%) success for palliation of malignant colonic obstruction with low mortality (0.6%) and complications including perforation (3.7%), migration (12%), and re-obstruction (7%). 3) Stenting allows for bridge to elective surgery, avoids colostomy, and results in shorter hospital stays compared to emergency surgery, though stents are an expensive option and other surgical approaches remain relevant.

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    Colonic Self Expanding Metallic Stents (SEMS) Indications & Contraindications

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    samer falcon
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    1) Colonic self-expanding metallic stents were introduced over 17 years ago to relieve malignant colonic obstructions as an alternative to emergency surgery or colostomy. 2) Studies show stenting has high rates of technical (92%) and clinical (88%) success for palliation of malignant colonic obstruction with low mortality (0.6%) and complications including perforation (3.7%), migration (12%), and re-obstruction (7%). 3) Stenting allows for bridge to elective surgery, avoids colostomy, and results in shorter hospital stays compared to emergency surgery, though stents are an expensive option and other surgical approaches remain relevant.

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    080621_NRajasagaram

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    1) Colonic self-expanding metallic stents were introduced over 17 years ago to relieve malignant colonic obstructions as an alternative to emergency surgery or colostomy. 2) Studies show stenting has high rates of technical (92%) and clinical (88%) success for palliation of malignant colonic obstruction with low mortality (0.6%) and complications including perforation (3.7%), migration (12%), and re-obstruction (7%). 3) Stenting allows for bridge to elective surgery, avoids colostomy, and results in shorter hospital stays compared to emergency surgery, though stents are an expensive option and other surgical approaches remain relevant.

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    19 views14 pages

    Colonic Self Expanding Metallic Stents (SEMS) Indications & Contraindications

    Uploaded by

    samer falcon
    1) Colonic self-expanding metallic stents were introduced over 17 years ago to relieve malignant colonic obstructions as an alternative to emergency surgery or colostomy. 2) Studies show stenting has high rates of technical (92%) and clinical (88%) success for palliation of malignant colonic obstruction with low mortality (0.6%) and complications including perforation (3.7%), migration (12%), and re-obstruction (7%). 3) Stenting allows for bridge to elective surgery, avoids colostomy, and results in shorter hospital stays compared to emergency surgery, though stents are an expensive option and other surgical approaches remain relevant.

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    of 14

    Colonic Self Expanding Metallic

    Stents
    (SEMS)
    Indications & Contraindications
    Niruben Rajasagaram
    General Surgery Registrar
    Colonic Stents
    Introduced over last 17
    years
    – 1st published use in 1991

    Historically initial SEMS


    used for colonic
    obstructions were
    designed for the
    oesophagus
    – Since been changed with
    development of a variety of
    colonic stents
    Table 1 Commercially available enteral stents

    Simmons DT and Baron TH (2005) Technology Insight: enteral stenting and new technology
    Nat Clin Pract Gastroenterol Hepatol 2: 365–374 doi:10.1038/ncpgasthep0236
    Colonic Stents
    Stent deployment
    – Fluoroscopic guidance
    – Colonoscopic guidance
    – Combined approach
    Colonic Stents
    Indications
    Malignant Colonic
    Obstruction
    – 7 to 29% of patients
    with colorectal cancers
    present with acute
    obstruction
    90% are located at or
    distal to the splenic
    flexure
    Colonic Stents- Indications

    Palliation
    – in patients with
    inoperable cancer
    Obstructive but
    localized colon
    malignancy & high risk
    for surgery
    Metastatic disease in
    whom resection offers
    no hope for surgical
    cure
    Colonic Stents- Indications
    Bridge to surgery
    – avoid emergency surgery

    permits bowel decompression

    High risk patients to be optimised


    prior to surgery

    thorough bowel preparation

    Shortened hospital & ICU stay

    – avoid stoma creation

    – single-stage colon resection


    Laparoscopic resection
    (19 of 23 patients
    Surgical Endoscopy 2007)
    Colonic Stents
    Evidence
    Palliation of malignant colonic obstruction
    – 2 Systematic Reviews
    29 case series (598 pts) BJS 2002
    54 studies (1198 pts) Am J Gastroenterology 2004
    Technical success 92%
    Clinical success 88%
    – Technical failure rate was higher for descending and more proximal
    tumours
    Mortality rate 0.6% (7 deaths – 6 Perforation)
    Complication
    – Perforation 3.7%
    – Migration 12%
    – Re-obstruction 7 %
    Overall results show stenting to be a safe technique with
    high success rates
    Colonic Stents
    Evidence
    Malignant Obstruction analysing decompression
    – 2 RCT (Surg Endoscopy 2004 & Anticancer Research 2004)
    – Colostomy VS Colonic stenting
    Both studies favoured use of stents and alleviated the need for
    colostomy with an overall positive impact on patients quality of life

    Malignant Obstruction Cost benefit analysis


    – Stents are expensive
    – Cost is offset by the shorter hospital stay and lower rate of
    colostomy formations
    (Gastrointestinal 2004 & Can J Gastroenterology 2006)
    Table 2 Summary of outcomes following enteral stent placement

    Simmons DT and Baron TH (2005) Technology Insight: enteral stenting and new technology
    Nat Clin Pract Gastroenterol Hepatol 2: 365–374 doi:10.1038/ncpgasthep0236
    Colonic Stents
    Contraindications
    Absolute
    – Perforation

    Relative
    – Long segments of stricture
    – Lesions that are too proximal and too distal
    – Lesions in tortuous portions of the colon
    – Intestinal ischaemia
    Conclusion
    Colonic Stents
    Converts emergency
    colectomy to an elective
    Not available everywhere
    particularly after hours
    and during weekends
    Other options of surgical
    management remain
    relevant
    – One stage resection (low
    risk patients)
    – Hartmanns
    – Simple colostomy
    Conclusion
    Colonic Stents

    What stent and which


    insertion technique
    – Society of
    gastrointestinal
    intervention
    Special topic for
    meeting is
    "Stenting in GI
    tract". (Oct 2008,
    S.Korea

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