Safety and efficacy of percutaneous cecostomy/colostomy for treatment of large bowel obstruction in adults with cancer Journal Article
| Authors: | Tewari, S. O.; Getrajdman, G. I.; Petre, E. N.; Sofocleous, C. T.; Siegelbaum, R. H.; Erinjeri, J. P.; Weiser, M. R.; Thornton, R. H. |
| Article Title: | Safety and efficacy of percutaneous cecostomy/colostomy for treatment of large bowel obstruction in adults with cancer |
| Abstract: | Purpose To assess the safety and efficacy of image-guided percutaneous cecostomy/colostomy (PC) in the management of colonic obstruction in patients with cancer. Materials and Methods Twenty-seven consecutive patients underwent image-guided PC to relieve large bowel obstruction at a single institution between 2000 and 2012. Colonic obstruction was the common indication. Patient demographics, diagnosis, procedural details, and outcomes including maximum colonic distension (MCD; ie, greatest transverse measurement of the colon on radiograph or scout computed tomography image) were recorded and retrospectively analyzed. Results Following PC, no patient experienced colonic perforation; pain was relieved in 24 of 27 patients (89%). Catheters with tip position in luminal gas rather than mixed stool/gas or stool were associated with greater decrease in MCD (-40%, -12%, and -16%, respectively), with the difference reaching statistical significance (P =.002 and P =.013, respectively). Catheter size was not associated with change in MCD (P =.978). Catheters were successfully removed from six of nine patients (67%) with functional obstructions and two of 18 patients (11%) with mechanical obstructions. One patient underwent endoscopic stent placement after catheter removal. Three patients required diverting colostomy after PC, and their catheters were removed at the time of surgery. One major complication (3.7%; subcutaneous emphysema, pneumomediastinum, and sepsis) occurred 8 days after PC and was successfully treated with cecostomy exchange, soft-tissue drainage, and intravenous antibiotic therapy. Conclusions Image-guided PC is safe and effective for management of functional and mechanical bowel obstruction in patients with cancer. For optimal efficacy, catheters should terminate within luminal gas. © 2015 SIR. |
| Keywords: | adult; clinical article; treatment outcome; aged; cancer patient; treatment indication; demography; computer assisted tomography; retrospective study; intervention study; echography; patient safety; cecostomy; interventional radiology; sepsis; endoscopic therapy; clinical effectiveness; intestine obstruction; catheter infection; catheter removal; fluoroscopy; colostomy; surgical patient; catheter complication; catheter occlusion; intestine distension; pneumomediastinum; large intestine disease; colon obstruction; subcutaneous emphysema; large bowel obstruction; human; male; female; priority journal; article; catheter dislodgment; cecostomy catheter; colostomy device; digestive stent; intestine parameters; maximum colonic distension; pericatheter stool leakage |
| Journal Title: | Journal of Vascular and Interventional Radiology |
| Volume: | 26 |
| Issue: | 2 |
| ISSN: | 1051-0443 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2015-02-01 |
| Start Page: | 182 |
| End Page: | 188 |
| Language: | English |
| DOI: | 10.1016/j.jvir.2014.09.022 |
| PROVIDER: | scopus |
| PUBMED: | 25529188 |
| DOI/URL: | |
| Notes: | Export Date: 2 April 2015 -- Source: Scopus |
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118Getrajdman -
540Weiser -
21Siegelbaum -
204Erinjeri -
249Sofocleous -
84Thornton -
110Petre -
3
Tewari
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