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, 2011, 917848

Colorectal Stenting in Malignant Large Bowel Obstruction: The Learning Curve

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Colorectal Stenting in Malignant Large Bowel Obstruction: The Learning Curve

D Williams et al. Int J Surg Oncol.

Abstract

Aim. Self-expanding metal stents (SEMSs) are increasingly used for the palliation of metastatic colorectal cancer and as a bridge to surgery for obstructing tumours. This case series analyses the learning curve and changes in practice of colorectal stenting over a three year period. Methods. A study of 40 patients who underwent placement of SEMS for the management of colorectal cancer. Patients spanned the learning curve of a single surgeon endoscopist. Results. Technical success rates increased from 82% initially, using an average of 1.7 stents per procedure, to a 94% success rate where all patients were stented using a single stent. There has been a change in practice from elective palliative stenting toward emergency preoperative stenting. Conclusion. There is a steep learning curve for the use of SEMS in the management of malignant colorectal bowel obstruction. We suggest that at least 20 cases are required for an operator to be considered experienced.

Figures

Figure 1
Figure 1
A series of images demonstrating the stages involved in endoscopically guided colorectal stenting. (a) The tumour is directly visualised with the endoscope, and the guide wire is passed through the end of the scope. (b) The deployment system is passed through the stricture. (c) The stent has been successfully deployed. The stent boundaries can be clearly identified.
Figure 2
Figure 2
A comparison between the first and second half of the case series showing the change in practice over time.

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