Self-Expanding Metal Stent Insertion by Colorectal Surgeons Using a Two-Person Approach Colonoscopy Without Fluoroscopic Monitoring in the Management of Acute Colorectal Obstruction: A 14-Year Experience

Abstract Background Placement of a self-expanding metal stent (self-expanding metal stent, SEMS) in patients presenting with kinds of colorectal disease as an acute colorectal obstruction (acute colorectal obstruction, ACO) may obviate emergency surgery(emergency surgery, ES), potentially effectively palliating incurable tumours, acting as a bridge to surgery (bridge to surgery, BTS) in patients with operable or potentially operable tumours and achieving effective decompression of other colorectal obstruction diseases. We present our experience with SEMS insertion by colorectal surgeons without fluoroscopic monitoring for ACO especially for acute malignant colorectal obstruction (acute malignant colorectal obstruction, AMCO) nearly a 14-year period (2007–2020).Methods We retrospectively reviewed the medical records of patients to identify all patients presenting to our unit with ACO especially with AMCO who had stenting carried out to achieve colonic decompression. All 434 procedures were performed by colorectal surgeons using a two-person approach colonoscopy and a conventional endoscope without fluoroscopic monitoring. Results The overall technique success rate by SEMS insertion was (428/434, 98.6%), the overall clinic success rate by SEMS insertion was (412/434, 94.9%), and the overall incidence of complications was (19/434, 4.4%). The complications included clinical perforation (6/434, 1.4%), stent migration (2/434, 0.5%), one of which re-stent; stent detachment (fell off)(3/434, 0.7%), none of them with re-stent; stool impaction (6/434, 1.4%), 1 of which re-stent; abdominal pain or anal pain (2/434, 0.5%). There was no hemorrhage in any of the 434 patients. Conclusions SEMS insertion is a relative safe and effective technique for colonic decompression in the dealing with ACO as either a bridge to subsequent resection surgery or as palliative measure, or solution to other causes such as recurrent tumor、benign diseases or extra-luminal compression. Therefore, ES was largely avoided.