Su1723 EFFICACY OF SELF EXPANDABLE METAL STENTS IN EXTRINSIC MALIGNANT COLONIC OBSTRUCTION. A 10-YEAR TERTIARY CARE CENTER EXPERIENCE

Abstract

Uncovered Self Expandable Metal Stents (SEMS) are frequently used for the management or palliation of secondary extrinsic malignant colon obstruction. The efficacy of SEMS in this setting may be inferior compared to primary colonic obstruction. We retrospectively reviewed all patients who underwent SEMS for colonic obstruction due to extrinsic malignant compression at our institution from 1/1/2007 to 8/1/2017. The primary outcome measures were technical and clinical success. Technical success was defined as successful stent deployment across the stricture in the desired location. Clinical success was defined as relief of obstructive symptoms. Patient and procedural related data including complications were summarized and analyzed. Descriptive statistics were used to summarize patient and procedure characteristics. Fisher’s exact test was used to calculate statistical significance between categorical variables. Logistic regression models were used to look for predictors of clinical success. The Kaplan-Meier method was used to calculate survival. A total of 199 patients underwent colonic stent placement over a 10-year period. Thirty-eight (19.1%) patients had malignant extrinsic compression. Technical success was achieved in all cases. Clinical success was achieved in 24 (63.2%) cases. Clinical failure occurred in 36.8%. Median time to stent failure was 5 days (IQR 3-7). Endoscopic revision was performed in 4 (10.5%) patients. Surgery after stent placement was performed in 7 (18.4%) patients. Patient and procedural characteristics are listed in table 1 and table 2. The most common source of metastasis was gastroesophageal 21.1%. The most common location of stricture was the rectosigmoid colon 89.5%. The median stricture length was 38mm(IQR 30-50). The most common stent size placed was 25 x 120mm (57.9%). Eleven (28.9%) patients required two or more stents placed in overlapping tandem fashion. Nineteen (50%) stents were placed at an “angled” configuration > 45 degrees. After univariate analysis, stents placed in a straight configuration (angulation < 45 degrees) were more likely to be clinically successful even though this was not statistically significant OR 2.52 (95%CI 0.65-9.8) p=0.18. The median survival time in patients who had a clinical response was 2.6 months versus 1.4 months in patients who had clinical failure or a complication (p=0.63). Uncovered SEMS placement for extrinsic colonic obstruction is associated with a high rate of technical success but a high rate of clinical failure. This information can be used to better inform patients and referring providers as well as develop strategies to improve palliation in this patient population.Tabled 1Table 1 Patient characteristics, abbreviations: IQR: interquartile rangeAge (median) (IQR)57 (48-70)GenderFemale n (%)22 (57.9)Symptom duration (median) IQR7 (2-10)Primary Malignancy n(%)Gastroesophageal8 (21.1)Peritoneal7 (18.4)Pancreatic6 (15.8)Small Bowel Carcinoid4 (10.5)Ovary/Uterine4 (10.5)Breast2 (5.3)Prostate2 (5.3)Lung2 (5.3)Other3 (7.9) Open table in a new tab Tabled 1Table 2 Colonic stent procedural details, abbreviations: IQR: interquartile rangeTechnical Success, n (%)38 (100)Clinical Success, n (%)24 (63.2)Stricture Location n (%)Recto-sigmoid colon34 (89.5)Transverse colon2 (5.3)Ascending colon2 (5.3)Stricture length, median, (IQR)38 (30-50)Stent Configuration n (%)Straight19 (50)Angled19 (50)Multiple stents, n (%)Overlapping tandem n10Multifocal stricture n1Endoscopic revision post stent n (%)4 (10.5)Flexible Sigmoidoscopy2Flexible Sigmoidoscopy with repeat stent2Complications n (%)4 (10.5)Perforation n2Readmission for pain n2 Open table in a new tab