Sa1547 The Full Covered Self-Expanding Metal Stent in the Management of Benign Esophageal Strictures: a Systematic Review

Abstract

Sa1546 Self-Expandable Metallic Stents in the Lower Gastrointestinal Tract Orhan Kocaman*, Ahmet Danalioglu, Hakan Senturk, Ali T. Ince, Kursat Turkdogan, Kemal Yildiz, Mukaddes Tozlu, Yusuf Kayar, Birol Baysal Gastroenterology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey Background: Interventional endoscopic and stenting techniques are continuously evolving and have enriched the therapeutic armamentarium of endoscopists. Transluminal endoscopic palliation of malignant and benign colorectal strictures in selected cases is more cost-effective and less invasive procedure compared to surgery. Objective: To assess the technical and clinical success, complications and outcomes of self-expandable metallic stents (SEMS) that were placed in the lower gastrointestinal tract (LGT). Methods: A total of 42 consecutive patients who underwent placement of SEMS for malignant and benign causes were included in the study between February 2011 and October 2013. The data analysed included patient demographics, primary illness, lesion type, localisation and length of stricture, type of stent, technical success, clinical success, complications, and survival. Clinical success was defined as amelioration of obstructive symptoms after stenting. All stents were placed through the scope and under fluoroscopic guidance. Covered, partially covered or uncovered SEMS were used at the discretion of the involved endoscopist. Results: Twenty-nine male and thirteen female patients’ data were analyzed. The mean age of the patients were 61 26 years (range: 33-90). A total of 45 SEMS (23.1% fully covered and 56.6% uncovered) was placed. Complaints were subileus in 40.5%, ileus in 40.5%, hematochezia in 7.1%, constipation in 7.1%, and abdominal pain in 4.8%. Etiology was malignant in 92.9% of patients and benign in 7.1%. Malignant etiology were mainly composed of adenocancer (90.5%); whereas benign etiology were mainly composed of radiation colitis (4.2%), Crohn’s disease (2.4%) and anastomotic stricture (2.4%). Of all patients, 64.1% had metastasis at the time of stenting. Stent locations were as follows: sigmoid colon 52.4%, rectum 26.2%, and others 21.4%. Technical and clinical success rates of stenting were 92.9% and 82.1%, respectively. Mean follow-up period was 87.4 days (0-365). Complications were observed in 43.6% of patients during follow-up period. Complications were as follows: migration 17.9%, ingrowth 15.4%, primary dysfunction 5.1%, and perforation 5.2%. Excluding the removed ones, mean stent patency was 90 days. Second stent was placed in three patients (7.7%) due to complications related with the first stent. Complication rate was higher in malignant strictures (pZ0.011) and with fully covered stents (pZ0.037). Technical success was higher in sigmoid colon (pZ0.042), and clinical success was lower in malignant strictures (pZ0.015). Conclusions: The placement of SEMS in the LGT has high technical and clinical success rates in the palliation of colorectal strictures. The most common complication was stent migration observed mostly in malignant strictures and with uncovered stents.