Editing Stents for LBO


== '''Selecting a stentable lesion''' ==

* Best between splenic flexure     and rectosigmoid
* Rectum beyond rectosigmoid     junction generally causes unbearable tenesmus, and carries a high risk of     stent migration
* Areas of acute angulation     (flexures) are hard in general
* Proximal colon is hard, but     theoretically feasible by specialists

== '''Indications''' (generally only malignant indications at this stage) ==

* Palliation for patients not     fit for resection, or with widespread metastases
* Pre-operative decompression
** Clinical stabilisation
** Allow bowel prep
** Pre-op colonoscopy to      exclude synchronous lesions
** Allows one-stage resection      and anastomosis
** Operate 5-10 days later

== '''Equipment''' ==

* Covered vs uncovered
** Covered are less likely to      get tumour ingrowth (3.8% vs 14.5%)
** Uncovered are less likely to      migrate (1.8% vs 21.1%)
** Uncovered are generally      preferred
* Generally deployed through     the scope

== '''Preparation''' ==

* In partial obstruction, prep     gently with PEG
* In complete obstruction,     consider giving an enema
* Prophylactic Abx
* If in doubt about ability to     traverse and stent, give a contrast enema - if contrast won't pass,     neither will the guidewire

== '''Technique''' ==

* Try to pass the lesion
* Don't dilate the lesion
* Pass a guidewire
* Confirm placement with     fluoroscopy
* Pass stent over the top and     expand in 1-2cm increments with fluoroscopy guidance

== '''Post-procedure''' ==

* Low-residue diet
** Avoid vegetables, fruits and      whole grains
* Stool softeners

== '''Efficacy''' ==

* Technical success - 97%
* Able to decompress colon     through stent within 96 hours - 97%
* For palliation, rate of     reintervention is 20%

== '''Complications''' ==

* Perforation (<5%)
** Immediate or delayed      (erosion)
** High-risk with bevacizumab      or radiation
* Migration 11%
** High risk
*** Benign lesions (doesn't       embed)
*** Stent too small
*** Tumour shrinks after       therapy
* Rectal bleeding - significant     bleeding is rare
* Recurrent obstruction
** Tumour can grow in at ends      of stent or through the stent - can be treated by argon photocoagulation      or laser or another stent

[[Category:Colorectal]]