Endoscopic stenting as bridge-to-surgery (BTS) in left-sided obstructing colorectal cancer: Experience with conformable stents

Background: Compared to emergency surgery, self-expandable metallic stents are effective and safe when used as bridge-to-surgery (BTS) in operable patients with acute colorectal cancer obstruction. In this study, we report data on the new conformable colonic stents. Objectives: To evaluate clinical effectiveness of conformable stents as BTS in patients with acute colorectal cancer obstruction. Design: This was a retrospective study. Settings: The study was conducted at six Italian Endoscopic Units. Patients: Data about patients with acute malignant colorectal obstruction were collected between 2007 and 2012. Main outcome measures: All patients were treated with conformable stents as BTS. Technical success, clinical success, rate of primary anastomosis and colostomy, early and late complications were evaluated. Results: Data about 88 patients (62 males) were reviewed in this study. Conformable SEMS were correctly deployed in 86 out of 88 patients, with resolution of obstruction in all treated patients. Tumor resection with primary anastomosis was possible in all patients. A temporary colostomy was performed in 40. Early complications did not occur. Late complications occurred in 11 patients. Stent migration was significantly higher in patients treated with partially-covered stents compared to the uncovered group (35% vs. 0%, P < 0.001). Endoscopical re-intervention was required in 12% of patients. One patient with rectal cancer had an anastomotic dehiscenceafter surgery and he was successfully treated with endoscopic clipping. One year after surgery, all patients were alive and local recurrence have not been documented. Limitations: This was a retrospective and uncontrolled study. Conclusions: Preliminary data from this large case series are encouraging, with a high rate oftechnical and clinical success and low rate of clinically relevant complications. Partially- coveredSEMS should be avoided in order to reduce the risk of endoscopic re- intervention. (C) 2016 Published by Elsevier Masson SAS.