P.1.329: ENDOSCOPIC PLACEMENT OF SELF-EXPANDABLE METAL STENTS FOR MALIGNANT COLONIC OBSTRUCTION: A REGIONAL MULTICENTER EXPERIENCE IN A LARGE COHORT OF TREATED PATIENTS

Abstract

Endoscopic Placement of Self-Expandable Metal Stents for Malignant Colonic Obstruction: A Regional Multicenter Experience in a Large Cohort of Treated Patients Roberto Di Mitri, Filippo Mocciaro, Mario Traina, Luigi M. Montalbano, Dario Raimondo, Clara Virgilio, Antonino Marino Gastroenterology Unit, A.R.N.A.S. “Civico Di Cristina Benfratelli” Hospital, Palermo, Italy; ISMETT, Palermo, Italy; Gastroenterology Unit, ”Villa Sofia-V. Cervello” Hospital, Palermo, Italy; Gastroenterology and Digestive Endoscopy Unit, San Raffaele-Giglio Hospital, Cefalu, Italy; Gastroenterology Unit, Garibaldi-Nesima Hospital, Catania, Italy Introduction: Self-expanding metal stents (SEMS) are a non-surgical option for treatment of malignant colorectal obstruction (CO) in symptomatic patients (pts), both as palliative treatment or bridging to surgery. With reported morbidity and mortality for emergency surgery as high as 39%, SEMS can be useful in resolving acute CO. Aims and methods: The aim of this study was to assess the efficacy and the safety of colonic SEMS placement, on elective or emergency bases, in a large cohort of symptomatic pts with malignant CO from 5 Sicilian tertiary centers. Between Jan. 2008 and Aug. 2010 the following patient data were collected: demographics, site and extension of neoplasia, indication (elective or emergency procedure), SEMS model, technical success, adverse events related to SEMS placement, quality of life (QoL), and survival. All pts signed informed consent before the procedure. Wallflex (Boston Scientific) and Evolution (Cook Medical) SEMS were placed under endoscopic guidance, with the aid of fluoroscopy, while Ultraflex Precision (Boston Scientific) SEMS were placed over the wire under fluoroscopy alone. All procedures were performed by experienced endoscopists, and took, on average, 30 minutes. Results: Ninety-five pts (54 male), with a mean age of 67.4 14.7, were evaluated. The CO was located in the rectosigma in 48 pts, the sigma in 19, descending colon in 10, transverse colon in 7, splenic flexure in 4, rectum in 4, ascending colon in 2, and hepatic flexure in 1. The mean length of the stenosis was 4.4 1.9 cm. Thirty-two pts (33.7%) were treated on an emergency basis, while 63 (66.3%) chose this treatment electively. Sixty-nine pts (72.7%) were treated palliatively, and 26 (27.3%) as bridge to surgery. Placed SEMS were: Wallflex in 77 pts, Evolution in 11, and Ultraflex Precision in 7. The mean follow-up was 9 7 months Technical success was achieved in 94/95 pts (98.9%), with colonic decompression and improvement of symptoms and QoL within 24 hours. Thirty-one of 32 pts (96.9%) treated on emergency basis achieved a significant clinical improvement. Seven pts required a second stent placement after a mean of 8.3 months because of ingrowth. Seven pts experienced an adverse event after SEMS placement: 2 perforations (2%) and 5 stent displacements (5%). Sixty-two pts died at the end of the follow up (68% of which treated palliatively and 32% as bridge to surgery). Conclusions: Our results, from a regional multicenter experience, confirm that SEMS, placed by experienced endoscopists, are safe and effective in inducing colonic decompression and symptomatic relief of malignant CO. In pts with severe acute obstruction, SEMS placement avoided the need for emergency surgery. SEMS can be a useful therapeutic approach in symptomatic pts before they undergo chemotherapy or surgical resection, and can improve outcomes and QoL.