24506142
OBJECTIVE	UK cancer guidelines recommend patients with colonic obstruction due to suspected malignancy be considered for stenting with a self-expanding metal stent ( SEMS ) .
OBJECTIVE	Considerable variation in practice exists due to a lack of expertise , technical difficulties and other , as yet ill-defined features .
OBJECTIVE	This retrospective multi-centre study aims to determine the outcome following colonic stenting for large bowel obstruction and identify factors associated with successful intervention .
METHODS	A regional programme of colonic stenting for large bowel obstruction , in five UK centres from 2005 to 2010 was evaluated for outcome including technical and clinical success , survival , complications and reoperation .
RESULTS	A SEMS was inserted in 334 patients , including 264 ( 79.0 % ) for palliation and 52 ( 15.6 % ) as a bridge to surgery .
RESULTS	Technical success was achieved in 292 ( 87.4 % ) patients , with 46 ( 13.8 % ) experiencing a complication or technical failure .
RESULTS	Reoperation was required in 39 ( 14.8 % ) patients stented for palliation of colorectal cancer of whom 16 ( 6.1 % ) subsequently required a colostomy .
RESULTS	A one-stage primary anastomosis was achieved in 35 ( 67.3 % ) of the 52 patients undergoing stenting as a bridge to resection .
RESULTS	Technical success did not vary by indication or site of obstruction ( P = 0.60 ) but was higher for operators who had performed more than 10 procedures ( OR 3.34 , P = 0.001 ) .
RESULTS	ASA grade 3 predicted a worse clinical outcome ( OR 0.43 , P = 0.04 ) .
RESULTS	The through-the-scope ( TTS ) endoscopy technique was more successful than radiological placement alone ( 90.3 % vs 74.8 % , P < 0.001 ) .
CONCLUSIONS	Experienced operators using a TTS technique achieved a better outcome for the emergency management of large bowel obstruction .
CONCLUSIONS	Older , sicker patients and those with extracolonic and benign strictures fared less well .

