Short-Term Outcomes of Colorectal Stenting Using a Low Axial Force Self-Expandable Metal Stent for Malignant Colorectal Obstruction: A Japanese Multicenter Prospective Study.

Takashi Sasaki,Tomonori Yamada,Toshio Kuwai,Shuntaro Yoshida,Mamoru Shimada,Akiko Narita,Rintaro Moroi,Nobuto Hirata,Yorinobu Sumida,Yoshihisa Saida,Masafumi Tomita,Hiroyuki Isayama,Toshiyuki Enomoto,Rika Kyo

doi:10.3390/jcm10214936

Abstract

(1) Background: Endoscopic colorectal stenting with high technical success and safety is essential in discussing the oncological outcomes for the management of malignant colorectal obstruction. Mechanical properties of self-expandable metal stents are usually considered to affect clinical outcomes. (2) Methods: A multicenter, prospective study was conducted in Japan. A self-expandable metal stent with low axial force was inserted endoscopically. The primary endpoint was clinical success, defined as the resolution of symptoms and radiological findings within 24 h. Secondary endpoints were technical success and adverse events. Short-term outcomes of 7 days were evaluated in this study. (3) Results: Two hundred and five consecutive patients were enrolled. Three patients were excluded, and the remaining 202 patients were evaluated. The technical and clinical success rates were 97.5% and 96.0%, respectively. Major stent-related adverse events included stent migration (1.0%), insufficient stent expansion (0.5%), and stent occlusion (0.5%). No colonic perforation was observed. There were two fatal cases (1%) which were not related to stent placement. (4) Conclusions: The placement of self-expandable metal stents with low axial force is safe with no perforation and showed high technical and clinical success rates in short-term outcomes for the management of malignant colorectal obstruction.

Highlights

Acute colorectal obstruction causes nausea, vomiting, abdominal pain, and bowel dilation
We focused on the short-term (7-day follow-up) safety and efficacy of this self-expandable metal stents (SEMSs) for the management of malignant colorectal obstruction
The present study showed that colorectal stenting for malignant colorectal obstruction using a SEMS with low axial force (Niti-S Enteral Colonic Uncovered Stent, D-type) was highly effective and safe in short-term evaluation

Summary

Introduction

Acute colorectal obstruction causes nausea, vomiting, abdominal pain, and bowel dilation. Malignancy is the most common cause of colorectal obstruction, and there are two causes of malignant colorectal obstructions: colorectal cancer and extra-colonic malignancies such as gastric, pancreaticobiliary, and gynecologic malignancies. The colorectal obstruction caused by advanced colorectal cancer occurs in 8–13% of cases, accounting for approximately 25% of all intestinal occlusions [1]. Colorectal stent placement is widely accepted for both palliation (PAL) and as a bridge to surgery (BTS). Colorectal stent placement is performed for the obstruction caused by colorectal cancer and extra-colonic malignancies. The European Society of Gastrointestinal Endoscopy (ESGE) guidelines suggest considering colorectal stent placement as an alternative to palliative surgical decompression for extra-colonic malignancy obstruction despite the technical and clinical success rates being lower than those reported for colorectal cancer obstruction [1,2]. No difference was observed in the clinical success rate between the two types of SEMSs (96% vs. 92%) and the fully covered SEMSs showed a higher migration rate (21% vs. 2%) and a trend of a lower tumor infiltration rate (4% vs. 15%) than the uncovered SEMSs [2]

Methods

Results

Conclusion