MANAGEMENT OF LARGE BOWEL OBSTRUCTION

ACPGBI Emergency General Surgery Sub-Committee – Recommendations for the

Management of Large Bowel Obstruction

Malignant large bowel obstruction is still a relatively common mode of presentation for

patients with colorectal cancer, occurring in up to 20% cases. It is associated with a high

morbidity and mortality, attributable in part to the patient population being elderly, often

with multiple comorbidities, but also, not insignificantly, sometimes due to inadequate or

untimely, delayed surgical management. Therefore, achieving optimum strategies for

treating such patients is deemed a priority by the ACPGBI to ensure improved clinical

outcomes.

The Association of Coloproctology of Great Britain and Ireland published a position

statement on the management of malignant large bowel obstruction in 2007. The full-text

version can be found at http://www.acpgbi.org.uk/content/uploads/Position-Statements-

on-Malignant-Large-Bowel-Obstruction-Anal-Fistula.pdf

More recent guidelines have been published by:

1. NICE https://www.nice.org.uk/guidance/cg131/ifp/chapter/acute-large-bowel-

obstruction

2. BMJ Best Practice http://bestpractice.bmj.com/best-

practice/monograph/877/treatment/step-by-step.html

The publications above were produced before The Crest Trial reported on stenting for

malignant large bowel obstruction. The trial reported at ASCO in 2016, and in brief

ACPGBI Emergency General Surgery Sub-Committee June 2017

 MANAGEMENT OF LARGE BOWEL OBSTRUCTION

demonstrated that, in patients fit enough to undergo surgery, stenting reduces stoma

formation without a detrimental effect on one-year survival

http://meetinglibrary.asco.org/record/125358/abstract

The latest ACPGBI Guidelines for the Management of Cancer of the Colon, Rectum and Anus

(2017) – Surgical Management, include guidance for the management of malignant large

bowel obstruction and the role of stenting

http://onlinelibrary.wiley.com/doi/10.1111/codi.13704/full

ACPGBI Emergency General Surgery Sub-Committee June 2017