Endoscopic stenting for malignant large-bowel obstruction as a management option for palliative patients in private medical practice: a case series and review of contemporary guidelines

Abstract

Background. Malignant bowel obstruction is a frequent complication of colorectal cancer and is associated with high mortality, frequent stoma formation, and a marked deterioration in quality of life, especially in incurable patients. In current guidelines of leading societies, self-expandable metal stents (SEMS) are considered a priority palliative option for the management of malignant bowel obstruction.

Objective. To demonstrate the clinical usefulness of endoscopic stenting in palliative patients with mechanical bowel obstruction and to compare the obtained results with contemporary international guidelines and data from the literature.

Materials and methods. A retrospective analysis was performed of three clinical cases of incurable patients from a private clinic with stage IV colorectal cancer complicated by large-bowel obstruction who underwent endoscopic placement of colonic stents (partially covered or uncovered). Clinical effect (resolution of obstruction), complication rate, and quality-of-life dynamics were assessed.

Results. In all three cases, a rapid clinical effect was achieved within 12–48 hours: restoration of spontaneous bowel movements, regression of abdominal pain and distension, stabilization of the general condition, and resumption of enteral nutrition. No procedure-related complications (perforation, bleeding, stent migration) were recorded, and no restenosis or progression of obstruction was observed during the mean stent patency of 3–4 months. All patients avoided emergency surgery and stoma formation, which had a positive impact on quality of life and psycho-emotional status.

Conclusion. Endoscopic stenting is an effective and minimally invasive palliative option in patients with malignant bowel obstruction, allowing avoidance of emergency surgery and stoma, reduction of early complications and hospitalization, and preservation of acceptable quality of life in the setting of limited life expectancy. The obtained results are consistent with ESGE recommendations and recent systematic reviews demonstrating the advantages of SEMS in the palliative treatment of patients with malignant intestinal disease complicated by obstruction.