Annals of Coloproctology

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Colorectal cancer

Colonic stenting: is the bridge to surgery worth its cost? A cost-effectiveness analysis at a single Asian institution: Michelle Shi Qing Khoo, Frederick H. Koh, Sharmini Su Sivarajah, Leonard Ming-Li Ho, Darius Kang-Lie Aw, Cheryl Xi-Zi Chong, Fung Joon Foo, Winson Jianhong Tan; Ann Coloproctol. 2024;40(6):555-563. Published online August 5, 2024; DOI: https://doi.org/10.3393/ac.2023.00738.0105

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2 Web of Science
4 Citations

Purpose
In patients with acute left-sided colonic obstruction, stenting can convert an emergency operation into a semi-elective procedure. However, its use continues to be debated. We performed a cost-effective analysis using our institution’s experiences.
Methods
Endoscopic, surgical, and financial details were prospectively collected for patients who presented with acute colonic obstruction and underwent stenting between 2019 and 2022. Outcomes were defined as technical/clinical success and successful surgical resection. The financial cost of stenting was compared with the expected cost without stenting.
Results
Forty patients were included, with 29 undergoing definitive resection. The most common pathology was primary colon cancer (27 patients, 93%). Endoscopic stenting had high technical (90%) and clinical (83%) success rates, with low rates of complications such as perforation (2 patients, 7%) and migration (0 patients, 0%). As a bridge to surgery, the median procedure time was 226 minutes and the surgical outcomes also showed a low rate of complications (3 patients, 11%), such as anastomotic leakage (0 patients, 0%), intraabdominal abscesses (2 patients, 7%), and 30-day postoperative mortality (0 patients, 0%). The cumulative costs with colonic stenting were $32,900, while the expected costs with emergency surgery, including stoma reversal, were $40,700 (healthcare cost-savings of $7,800 per person). The difference was mainly due to the avoidance of upfront emergency surgery. The incremental cost-effectiveness ratio was 0.81, favoring colonic stenting over upfront emergency surgery.
Conclusion
Colonic stenting as a bridge to surgery is safe and cost-effective for treating left-sided colonic obstruction with high success rates and low complication rates.

Citations

Citations to this article as recorded by

Nationwide Analysis of Right-Sided Colonic Stenting: Rarely Used but Reduces Stoma Creation Significantly
Khalid Ahmed, Ahmed Dirweesh, Zachary D. Leslie, Yasmin Ali, Nabeel Azeem, Eric Wise, Cyrus Jahansouz, Martin Freeman, Stuart K. Amateau
Techniques and Innovations in Gastrointestinal Endoscopy.2026; 28(1): 250952. CrossRef
Predictors of perforation following colorectal stenting in patients with acute intestinal obstruction
K.I. Seurko, A.N. Kosenkov, E.V. Stolyarchuk, K.I. Seurko, S.A. Grashchenko, D.A. Stribunov
Pirogov Russian Journal of Surgery.2026; (3): 33. CrossRef
Endoscopic Stenting Followed by Laparoscopic Resection in Malignant Colonic Obstruction: Oncological Safety of the Bridge-to-Surgery Approach
Deniz Öçal, Mehmet Torun
Turkish Journal of Colorectal Disease.2026;[Epub] CrossRef
Global Use and Outcomes of Endoscopic Stenting in Acute Malignant Left-Sided Colonic Obstruction: A Secondary Analysis of APOLLO, An International, Prospective Cohort Study

Diseases of the Colon & Rectum.2025; 68(12): 1458. CrossRef

Colorectal cancer

Obstructing colorectal cancer: a population-based review of colonic stenting in Queensland, Australia: Cian Keogh, Julie Moore, Danica Cossio, Nick Smith, David A. Clark; Ann Coloproctol. 2024;40(3):268-275. Published online June 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00640.0091

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Abstract PDF: Purpose
Stenting is a useful treatment option for malignant colonic obstruction, but its role remains unclear. This study was designed to establish how stents have been used in Queensland, Australia, and to review outcomes.
Methods
Patients diagnosed with colorectal cancer in Queensland from January 1, 2008, to December 31, 2014, who underwent colonic stent insertion were reviewed. Primary outcomes of 5-year survival, 30-day mortality, and overall length of survival were calculated. The secondary outcomes included patient and tumor factors, and stoma rates.
Results
In total, 319 patients were included, and distant metastases were identified in 183 patients (57.4%). The 30-day mortality rate was 6.6% (n=21), and the 5-year survival was 11.9% (n=38). Median survival was 11 months (interquartile range, 4–27 months). A further operation (hazard ratio [HR], 0.19; P<0.001) and chemotherapy and/or radiotherapy (HR, 0.718; P=0.046) reduced the risk of 5-year mortality. The presence of distant metastases (HR, 2.052; P<0.001) and a comorbidity score of 3 or more (HR, 1.572; P=0.20) increased mortality. Surgery was associated with a reduced risk of mortality even in patients with metastatic disease (HR, 0.14; P<0.001). Twenty-two patients (6.9%) ended the study period with a stoma.
Conclusion
Colorectal stenting was used in Queensland in several diverse scenarios, in both localized and metastatic disease. Surgery had a survival advantage, even in patients with metastatic disease. There was no survival difference according to whether patients were socioeconomically disadvantaged, diagnosed in a major city or not, or treated at private or public hospitals. Stenting proved a valid treatment option with low stoma rates.

Benign bowel disease

Ileostomy volvulus as an underreported problem causing small bowel obstruction in patients living with ostomy: a case report and literature review: Julianna Seo, Ishith Seth, Dilshad Dooreemeah, Chun Hin Angus Lee; Ann Coloproctol. 2024;40(5):424-430. Published online March 2, 2023; DOI: https://doi.org/10.3393/ac.2022.00976.0139

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Abstract PDF Supplementary Material: Purpose
Ileostomy volvulus is a rare cause of small bowel obstruction. We present an unusual case of ileostomy volvulus without the presence of adhesions. Additionally, a systematic literature review was performed to collate the current literature on the causes, diagnosis, treatment, and preventative measures of ileostomy-related small bowel obstruction.
Methods
PubMed (MEDLINE), Embase, Google Scholar, Scopus, and CENTRAL were searched from their inception up to August 2022. This study adhered to the PRISMA guidelines and was registered on PROSPERO. The primary outcomes included patients’ demographics, imaging modality, indication for initial surgery, type and configuration of stoma, surgical treatment, and recurrence of volvulus. The quality of included studies was assessed using the Murad tool. Written informed consent was obtained from the patient.
Results
Seven studies were included, comprising 967 patients. Stoma outlet obstruction (SOO) was reported in all 159 patients, and 12 had ileostomy volvulus as the cause. A majority of patients had loop ostomies for ileostomy volvulus. No complications or mortality were reported in the included studies, and half of the included studies were deemed to be of good quality.
Conclusion
This case demonstrates the need for high clinical suspicion of SOO in patients with loop ileostomy, and rapid management should be undertaken. Whilst loop ileostomies, increased rectus abdominal muscle thickness, and lower preoperative total glucocorticoid dosage are associated with SOO, large-scale retrospective studies are needed to validate our findings.

Stoma

Benefits and risks of diverting stoma creation during rectal cancer surgery: Masaya Kawai, Kazuhiro Sakamoto, Kumpei Honjo, Yu Okazawa, Rina Takahashi, Shingo Kawano, Shinya Munakata, Kiichi Sugimoto, Shun Ishiyama, Makoto Takahashi, Yutaka Kojima, Yuichi Tomiki; Ann Coloproctol. 2024;40(5):467-473. Published online December 5, 2022; DOI: https://doi.org/10.3393/ac.2022.00353.0050

6,803 View
127 Download
9 Web of Science
11 Citations

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