Efficacy Analysis Of Endoscopic Intestinal Stent Placement In Patients With Malignant Colorectal Obstruction

Objective: To observe the efficacy of simple endoscopic intestinal stent placement in patients with colorectal cancer obstruction.Methods: Retrospectively collected 133 patients with colorectal cancer obstruction treated by Fujian Medical University Union Hospital from January 2017 to February2019,of which 48(36.1%)underwent palliative simple endoscopic guided stent placement.Another 85 patients(63.9%)underwent simple endoscopic implantation to improve the symptoms of obstruction,and then switched to surgical treatment.By collecting the clinical data of patients,the success rate of intestinal stent placement,the rate of obstruction removal,the time to recovery of gastrointestinal tract,and the incidence of intestinal stent complications were analyzed.The clinical data of left and right colon cancer with simple endoscopic guided stent placement were further analyzed.Results: Of the 133 patients,127 were successfully placed with a stent,and the technical success rate was 95.49%(127/133).After clinical symptoms,signs,and re-examination imaging findings,125 cases of intestinal obstruction were relieved,and the initial clinical success rate was 98.43%(125/127).During postoperative follow-up,intestinal perforation occurred in 1.57%(2/127),stent displacement occurred in 4.72%(6/127),and intra-stent re-occlusion occurred in 2.36%(3/127).Of the 48 palliative patients,4 patients failed stent placement,2 patients were successfully placed with stent but the obstruction was not significant relived within 24 hours,and the remaining42 palliative patients were successfully placed with stent and the obstruction was relieved within 24 hours.One patient died,of which one had a displacement 180 days after stent placement,two had intestinal perforations 193 and 63 days after stent placement,and two had stent re-obstructions 48 and 110 days after stent placement,respectively.Six patients died in the group of bridge to surgery(BTS)and 79 patients were still alive at follow-up.Six of them underwent preoperative neoadjuvant chemotherapy or postponed surgery for personal reasons,during which intestinal stent complications occurred.Stent displacement occurred in 5 cases at 45 days,58 days,60 days,74 days,and 117 days after stent placement,and 1 case occurred intra-stent re-obstruction after stent placement in 182 days.Comparative analysis of clinical data of patients with left and right colon cancer and intestinal obstruction showed that there was no statistically significant difference in sex composition ratio,obstruction,status of placement and complications after placement of left and right colon cancer(P>0.05).However,there was a significant statistical difference in the comparison of the setting time(P <0.05).Conclusion: Simple endoscopic guided intestinal stent placement is safe and effective in treating patients with colorectal cancer obstruction,which can significantly improve the symptoms of patients with obstruction and the quality of life in palliative patients for a long time.Moreover,the patients with surgical indications can obtain stage I anastomosis,which avoids the physical and psychological pain and high medical loss caused by emergency surgery and intestinal ostomy.