Endoscopic stenting as a bridge to elective surgery versus emergency laparotomy for patients with acute malignant large bowel obstruction

Objectives
To evaluate the effect of colonic decompression using endoscopic colonic stenting (ECS) followed by elective surgery versus emergency surgical intervention in cases of acute obstructive malignancy of the colon.
Patients and methods
The current prospective comparative study includes 60 patients who presented with a picture of acute malignant colonic obstruction. The large bowel obstruction was defined as colonic dilation with multiple air-fluid levels on plain abdominal radiograph plus the findings of an abdomen computed tomography result compatible with a malignant stricture. Patients were classified according to the type of management into emergency surgery (ES) and ECS. Data were gathered and analyzed.
Results
In the ES group, 18/30 (60%) patients had a resection and primary anastomosis, 8/30 (26.7%) patients underwent Hartman’s operation, whereas the remaining 4/30 (13.3%) underwent colostomy only. In the ECS group, 24/30 (80%) patients had a resection and primary anastomosis in an elective surgery, whereas the remaining 6/30 (20%) cases had a diverting stoma. All patients with obstructed colon cancer on the right side showed a clinical and technical success rate of 100% in both groups. However, obstructed colon cancer on the left side did not show the same rate of success in ES and ECS group. The ECS group showed a remarkably lower (=0.02) rate of ICU admission than the ES group. The mean total hospital admission was remarkably longer (=0.047) in the group ES group compared with the ECS group. Postoperative complications were remarkably higher (=0.028) in the ES group compared with the ECS group.
Conclusion
ECS for patients having acute malignant right or left colonic obstruction is a safe and effective procedure, with excellent technical and clinical success rates.