P2293 - Colonic Stenting of Obstructing Colorectal Carcinomas as a Bridge to Surgery

Brandon T. Nguyen, BS¹, Susan Y. Li, BS¹, Sadie De Silva, MD², Vivaik Tyagi, MD³, Kumaravel Perumalsamy, MD³, Duminda Suraweera, MD^3
1Western University of Health Sciences, Lancaster, CA; ²UHS Southern California Medical Education Consortium, Temecula, CA; ³Gastro Care Institute, Lancaster, CA

Introduction: The use of self-expanding metal stents (SEMS) in the management of obstructing colorectal carcinomas have historically been limited for palliative purposes. However, their use as a “bridge” to elective surgery has now been accepted. We provide a case series of four patients who successfully underwent colonic stenting for this purpose.

Case Description/Methods: Case 1: A 62-year-old male with a past medical history of diabetes presented with abdominal pain. Computed tomography (CT) showed an apple core like lesion in the distal transverse colon with proximal dilation of both colon and small bowel. Colonoscopy was performed showing an obstructing colon mass in the distal transverse colon and splenic flexure. Biopsies were obtained and a 25 mm x 90 mm uncovered SEMS was placed under fluoroscopic guidance. Patient did well post procedure and underwent a hemicolectomy five days later after bowel preparation.

Case 2: A 82-year-old male with history of hypertension presented with abdominal pain and rectal bleeding. CT showed moderately distended small bowel and ascending colon. Colonoscopy showed a large circumferential friable mass in the proximal transverse colon extending into the hepatic flexure with obstruction of the colon. Biopsies were obtained and a 25 mm x 90 mm uncovered SEMS was placed. Patient did well post procedure and was discharged. He underwent neoadjuvant chemotherapy and proceeded to elective surgery with hemicolectomy five months later.

Case 3: A 60-year-old male with no significant past medical history presented with nausea and vomiting. CT showed a partially obstructing mass at the hepatic flexure. Colonoscopy confirmed a mass with biopsies obtained. A 25mm x 120mm SEMS was placed under fluoroscopic guidance. Patient successfully underwent bowel prep and hemicolectomy three days later.

Case 4: A 61-year-old male with history of hypertension presented with abdominal pain. CT showed colon thickening at rectosigmoid junction and numerous liver lesions concerning for metastasis. Colonoscopy showed obstructing rectosigmoid mass. Biopsies were obtained and a 25mm x 90mm uncovered SEMS was placed under fluoroscopic guidance. Patient did well post procedure and was discharged with follow up with Oncology for further management.

Discussion: The use of SEMS in obstructing colorectal carcinomas is a safe and effective method to manage acute bowel obstructions, providing much needed time for full oncologic evaluation and functions well as a bridge-to-surgery.


Figure: Figure 1: (a) Deployment of stent in Case 1. (b) Deployed stent in Case 2. (c) Deployed stent in Case 3. (d) Fluoroscopy of deployed stent in Case 4.


Disclosures:
Brandon Nguyen indicated no relevant financial relationships.
Susan Li indicated no relevant financial relationships.
Sadie De Silva indicated no relevant financial relationships.
Vivaik Tyagi indicated no relevant financial relationships.
Kumaravel Perumalsamy indicated no relevant financial relationships.
Duminda Suraweera indicated no relevant financial relationships.


Brandon T. Nguyen, BS¹, Susan Y. Li, BS¹, Sadie De Silva, MD², Vivaik Tyagi, MD³, Kumaravel Perumalsamy, MD³, Duminda Suraweera, MD³. P2293 - Colonic Stenting of Obstructing Colorectal Carcinomas as a Bridge to Surgery, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.