EP502 - Clinical outcomes of self-expanding colonic metal stents in large bowel obstructions, a single institution experience

ePoster Presenter(s)

• 

  Carlos Fairen Oro, Fellow (he/him/his)

  Colon and Rectal Surgery Fellow
  UMass Chan Medical School
  UMass Chan Medical School
  Worcester, MA, United States

  Disclosure information not submitted.

Author(s)

• 

  Benjamin Gallant, MD

  General Surgery Resident
  UMass Chan Medical School
  UMass Chan Medical School
  Worcester, MA, United States

  Disclosure information not submitted.
• 

  Andrew Hu, MD

  General Surgery Resident
  UMass Chan Medical School
  University of Massachusetts T.H Chan Medical School
  Worcester, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Justin Maykel, MD

  Chief, Division of Colorectal Surgery
  UMass Memorial Health
  UMass Chan Medical School
  Worcester, MA, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Karim Alavi, MD, MPH

  Associate Professor of Surgery, Director, Colon and Rectal Surgery Fellowship
  UMass Chan Medical School
  southborough, Massachusetts, United States

  Disclosure information not submitted.

Author(s)

• 

  Tess H. Aulet, MD (she/her/hers)

  Colorectal Surgeon
  UMass Memorial Medical Center
  UMass Memorial Medical Center
  Worcester, Massachusetts, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.
• TP

  Thomas Peponis, MD, FACS

  Colon and Rectal Surgeon, Assistant Professor of Surgery
  University of Massachusetts
  Worcester, Massachusetts, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• GA

  Gabrielle Arcand, n/a

  Medical Student
  University of Massachusetts Medical School
  Sutton, Massachusetts, United States

  Disclosure information not submitted.
• AL

  Anqi Liu, MD

  General Surgery Resident
  UMass Chan Medical School
  Shrewsbury, Massachusetts, United States

  Disclosure information not submitted.
• KT

  Katherine Tak, BA

  Medical Student
  UMass Chan Medical School
  Worcester, Massachusetts, United States

  Disclosure information not submitted.
• PS

  Paul R. Sturrock, MD

  Assistant Professor of Surgery
  UMassMemorial Medical Center
  Worcester, Massachusetts, United States

  Disclosure information not submitted.

Purpose/Background: Self-expanding metal stents (SEMS) have been increasingly used to relieve large bowel obstructions, either as a palliative measure or as a bridge to surgery. Known complications include migration, stent obstruction, hemorrhage or perforation with potential upstaging of colon and rectal cancer. We aimed to investigate our clinical outcomes with the use of SEMS for benign and malignant large bowel obstruction.

Methods/Interventions: We identified patients that had colonic SEMS placed in our institution by colorectal surgeons from November 2017 to August 2025. Patient demographics and comorbidities were collected. Inclusion criteria were patients who came in with symptomatic colonic obstruction from either benign or malignant etiologies in which a stent was placed as a bridge to surgery or for palliation. Variables included location of the obstruction, periprocedural complications such as bleeding, migration, perforation, stent obstructions and need for emergent surgery after stent placement. Oncologic variables including tumor staging, recurrence and ability to complete neoadjuvant and/or adjuvant therapy were analyzed.

Results/Outcomes: 54 patients had SEMS placed in our institution. 42 patients (77.8%) had a stent placed for malignant large bowel obstruction and 12 patients (22.2%) for benign strictures. 19 patients (35.2%) had stent placed for palliative intent and 35 patients (64.8%) had the stent placed with intentions to bridge to a definitive surgery in an elective setting. Eleven (21.4%) patients suffered a technical complication related to the stent and 9 of the 11 (81.8%) patients required an operation to manage the complication (Table 2). 5 (41.6%) out of 12 patients who had stents placed for benign disease had a stent complication. 6 (14.3%) out of 42 patients who had stents placed for malignant disease suffered a stent complication. 8 (72.7%) out of 11 complications were related to stents placed in the sigmoid colon. Of 10 patients who had a resectable malignant bowel obstruction and were eligible for neoadjuvant therapy, 7 (70%) were able to complete neoadjuvant treatment and oncologic resection of the tumor. 65.2% of the bridge to surgery patients avoided a stoma after stent placement. Only 3 patients (7.7%) who had a malignant bowel obstruction and a SEMS placed as bridge to surgery developed distant recurrence after surgery. No local recurrence was noted after oncologic resection in our cohort.

Conclusion/Discussion: SEMS are a feasible option for patients with malignant large bowel obstructions. Select patients with benign large bowel obstructions may benefit from SEMS, accepting a higher rate of technical failure and reintervention compared to malignant bowel obstructions. In experienced hands, the majority of patients are able to avoid a stoma. A majority of patients with resectable malignant bowel obstruction eligible for neoadjuvant therapy are able to complete oncologic treatment after placement of colonic stent.

Clinical outcomes of self-expanding colonic metal stents in large bowel obstructions, a single institution experience
Demographic data
Clinical outcomes of self-expanding colonic metal stents in large bowel obstructions, a single institution experience
Stent placement characteristics and oncologic outcomes