Colonic Stenting Research Articles

Endoscopic Stenting Does Not Worsen Long Term Outcomes Amongst Patients Presenting with Obstruction from Colorectal Cancers.

Stenting has been increasingly adopted in colorectal cancer patients presenting with acute large bowel obstruction. However, long-term outcomes of stenting are lacking in the literature. Our study attempts to compare the long-term outcomes of colonic stenting and emergency surgery amongst left-sided colorectal cancer patients presenting with acute large bowel obstruction. A retrospective review of all patients who presented with nonmetastatic colorectal cancer who underwent either endoscopic stenting or emergency surgery for acute large bowel obstruction was performed from January 2007 to April 2016. Patients were analysed in an intention-to-treat analysis. Forty-seven (46.1%) patients underwent emergency surgery, whereas 55 (53.9%) underwent colonic stenting with a technical success rate of 71.0%. Patients who underwent emergency surgery were more likely to develop severe complications compared with patients who underwent successful colonic stenting, but the difference was not statistically significant (odds ratio [OR] 2.84; 95% confidence interval [CI] 0.71-11.3, p=0.139). Patients were followed up for a median of 48.3 months (3.1-111) in the stenting group and 51.2 months (1.2-117.1) in the emergency surgery group. Recurrence rates between colonic stenting and emergency surgery were similar (25.6% vs. 21.3%, p=0.500), with more anastomotic and peritoneal recurrences were noted in the emergency surgery group. 5 year disease free survival (77% vs. 73%, p=0.708) and overall survival (86% vs. 62%, p=0.064) also were similar. Patients who underwent endoscopic stenting for large bowel obstruction have comparable long-term outcomes as those who undergo emergency surgery. The role of endoscopic stenting in obstructed colorectal cancers merits further evaluation.

Colonic Stenting in the Management of Acute Left-sided Malignant Colonic Obstruction is Oncologically Safe?

The management of patients presenting with acute large bowel obstructioncaused by left sided colorectal cancer is still debated.Colonic stenting (CS) seems to be a good therapeutical option toemergency surgery: it is able to convert an urgent situation in anelective one. Lately conflicting results were published about thistechnique used as bridge to surgery in comparison with the emergencysurgery in terms of oncologic safety and recurrence rate.Actually self expandable metallic stents (SEMS) are not “allowed”to treat potentially curable patients. Data reported in literatureshow that colonic stenting improves primary anastomosis ratewith a low stoma creation in comparison with emergency surgery,enhancing patients’ quality of life, without differences in terms ofmortality and morbidity rate. According to available data, at oneyear follow up time, the recurrence rate is higher in patients treatedwith stent, with no statistical difference in terms of disease freesurvival and overall survival.Endoscopist’s experience, type of colic obstruction (partial or total),type of stent, insertion technique and timing of surgery arefundamental to reach CS technical and clinical success.Oncologic (un)-safety of colonic stenting has to be still investigatedand confirmed by medium and long term follow up of largeprospective studies and randomized controlled trials comparingSEMS and ES.

Colonic Self-Expandable Metallic Stents for Patients with Colorectal Cancer Obstruction Induced Sepsis

To determine whether using colonic self-expandable metallic stents (SEMS) as a bridge to surgery for patients with colorectal cancer obstruction induced sepsis (CRCOIS) have better health outcomes compared with emergency surgery (ES). The patients with CRCOIS were enrolled from three university hospitals in China and retrospectively divided into SEMS group (n=32) or ES group (n=20). A total of 52 patients met the inclusion criteria. SEMS group had less the incidence of deep vein thrombosis (P<0.01) and number of organ dysfunction (P<0.01) than ES group. Kaplan-Meier curve showed no significant difference is found in term of 360-day overall survival between the two groups (log-rank test, P = 0.12). However, Multivariable analysis showed the pathological stages (OR: 1.26, 95%CI: 0.72-1.63, P<0.01) and number of organ failure (OR: 0.95, 95%CI: 0.71-1.42, P<0.01) are independent risk factors for 360-day overall survival. Therefore, SEMS placement as a bridge to surgery followed by selective surgery is a feasible and safe procedure for patients with CRCOIS, provides significant advantages of prognosis such as reducing the length of hospital stay, and decreasing the incidence of deep venous thrombosis and organ dysfunction.

MINIMALLY INVASIVE APPROACH FOR RIGHT-SIDED COLON CANCER, COMPLICATED BY LARGE-BOWEL OBSTRUCTION

The case demonstrates an opportunity of safe and successful colonic stenting to treat bowel obstruction with following laparoscopic radical intervention for right-sided colon cancer localization. The colonic stent as a “bridge to the surgery” improves immediate results and surviving rate in elderly patients with complicated right-sided colon cancer and severe concomitant disease.

Colonic stenting in the surgical treatment of colorectal cancer complicated by ileus

Colonic stenting in the surgical treatment of colorectal cancer complicated by ileus

Endoscopic approach to anastomotic leaks: partially covered self-expandable stents. A single center’s experience

&lt;b&gt;Introduction&lt;/b&gt;: Anastomotic leakage is an important and undesirable major complication after upper and lower gastrointestinal surgery. This complication can lead to significant morbidity and mortality and prolonged hospital stay. The objective of this study was to evaluate the safety and technical and clinical outcomes of temporary partially covered self-expandable metallic stent (PCSEMS) placement for treating anastomotic leaks after gastrointestinal tract surgery.&lt;br /&gt; &lt;b&gt;Material and methods&lt;/b&gt;: Medical records of 9 patients who had undergone partial covered self-expandable esophageal or colonic stenting either for colorectal anastomotic leak or esophageal anastomotic leak in Kartal Kosuyolu Higher Specialty Training and Research Hospital between April 2012 and October 2015 were collected. Living patients were recalled for the policlinic follow-up and recent status was recorded.&lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;: The mean age was 57 (37–78) years. Six of the patients were male and 3 of them female. Stents were successfully placed in all patients in the fistula localization on the first attempt. Stent migration was encountered in 3 patients and restenting was performed in 2 of these patients. No complications were seen related to the indwelling stents. Stent treatment failure occurred in 2 of the 9 patients. The mean removal time of the stent was 43 (5–70) days and it was not possible to get the stent out in 1 patient.&lt;br /&gt; &lt;b&gt;Conclusions&lt;/b&gt;: Endoscopic stenting is a minimally invasive and highly effective procedure that gives promise for the treatment of fistula after digestive surgery in the future.

Endoscopic Stenting as Bridge to Surgery versus Emergency Resection for Left-Sided Malignant Colorectal Obstruction: An Updated Meta-Analysis.

Introduction Emergency resection represents the traditional treatment for left-sided malignant obstruction. However, the placement of self-expanding metallic stents and delayed surgery has been proposed as an alternative approach. The aim of the current meta-analysis was to review the available evidence, with particular interest for the short-term outcomes, including a recent multicentre RCT. MethodsWe considered randomized controlled trials comparing stenting as a bridge to surgery and emergency surgery for the management of left-sided malignant large bowel obstruction, performing a systematic review in MEDLINE, PubMed database, and the Cochrane libraries. ResultsWe initially identified a total of 2543 studies. After the elimination of duplicates and the screening of titles and abstracts, seven studies, for a total of 448 patients, were considered. The current meta-analysis revealed no difference in the mortality rate between the stent group and the emergency surgery group; the postoperative complication rate (37.84% versus 54.87%, P = 0.02), the stoma rate (28.8% versus 46.02%, P < 0.0001), and the incidence of wound infection (8.11% versus 15.49%, P = 0.01) were reduced after stent as a bridge to surgery. Conclusion Colonic stenting as a bridge to surgery appears to be a safe approach to malignant large bowel obstruction. Possible advantages of this treatment can be identified in a reduced incidence of postoperative complications and a lower stoma rate. Further RCTs considering long-term outcomes and cost-effectiveness analysis are needed.

Perspectives on large bowel obstruction

Large bowel obstruction (LBO) is a serious and costly medical condition, indicating often emergency surgery. The main clinical issue is to determine whether the obstruction affects the small bowel or the colon since the causes and treatments are different. Delay in operative intervention may lead to an unnecessary bowel resection, increased risk of perforation, and overall worsening of patient morbidity and mortality. With the advent of colonic endoluminal stent, the treatment of distal colonic obstruction should be individually tailored to each patient. This article discussed LBO and emphasized the importance of history taking, examination, and basic imaging in the early diagnosis of its cause, thus facilitating appropriate management.

Preoperative colonic stentsvsemergency surgery for acute left-sided malignant colonic obstruction: Meta-analysis with systematic review of the literature

Preoperative colonic stents vs emergency surgery for acute left-sided malignant colonic obstruction: Meta-analysis with systematic review of the literature

Key statistical assumptions and methods in one-arm meta-analyses with binary endpoints and low event rates, including a real-life example in the area of endoscopic colonic stenting

AbstractThere are relatively few publications on the methodology of one-arm meta-analyses, especially when the outcome is binary and has low probability of occurring. We will discuss a few of the important assumptions underlying one-arm meta-analyses, including publication bias, fixed effect versus random-effects models, and raw event incidence rate transformations required when the event frequency is low. Finally, we will provide a real-life example taken from the endoscopic colonic stenting literature to illustrate the consequences of failure to thoroughly investigate these assumptions. In this example, we find arcsine transformation provides more appropriate results than logit transformation.

Treatment of Postoperative Leaks of the Upper Gastrointestinal Tract with Colonic Self-Expandable Metal Stents

Introduction: The use of self-expandable metal stents (SEMS) for the treatment of postoperative leaks of the upper gastrointestinal tract is already established. However, there are discrepancies between the relatively small caliber of the esophageal stents available and the postsurgical luminal size, which may determine an inadequate juxtaposition. As colonic stents have a bigger diameter, they might be more adequate. Additionally, stents with a larger diameter might have a lower risk of migration. Materials and Methods: The aim of this study was to evaluate the efficacy and complications associated with the use of colonic fully covered SEMS (FSEMS) in the treatment of postoperative leaks in critical patients. All patients with postoperative leaks of the upper gastrointestinal tract treated with colonic stents (Hanarostent® CCI) between 2010 and 2013 were retrospectively included. Results: Four patients with postoperative leaks were treated with colonic SEMS. The underlying surgeries were a gastric bypass, an esophagogastrectomy for Boerhaave syndrome, a primary repair of esophagopleural fistula due to Boerhaave syndrome, and an esophagectomy due to esophageal cancer. The leaks were detected on average 17 days after the initial surgery. All patients needed admission to a critical care unit after index surgery. Stent placement was technically feasible in all patients. The median residence time of the stents was 7 weeks, and no complications were verified when they were removed. There were no cases of stent migration. The treatment was successful in all patients, with complete healing of the leaks. Discussion and Conclusions: The placement of colonic FSEMS seems to be successful and safe in the treatment of postoperative leaks of the upper gastrointestinal tract.

Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial).

The aim of colonic stenting with self-expandable metallic stents in neoplastic colon obstruction is to avoid emergency surgery and thus potentially reduce morbidity, mortality, and need for a stoma. Concern has been raised, however, about the effect of colonic stenting on short-term complications and long-term survival. We compared morbidity rates after colonic stenting as a bridge to surgery (SBTS) versus emergency surgery (ES) in the management of left-sided malignant large-bowel obstruction. This multicentre randomised controlled trial was designed with the endorsement of the European Association for Endoscopic Surgery. The study population was consecutive patients with acute, symptomatic malignant left-sided large-bowel obstruction localised between the splenic flexure and 15cm from the anal margin. The primary outcome was overall morbidity within 60days after surgery. Between March 2008 and November 2015, 144 patients were randomly assigned to undergo either SBTS or ES; 29/144 (13.9%) were excluded post-randomisation mainly because of wrong diagnosis at computed tomography examination. The remaining 115 patients (SBTS n=56, ES n=59) were deemed eligible for analysis. The complications rate within 60days was 51.8% in the SBTS group and 57.6% in the ES group (p=0.529). Although long-term follow-up is still ongoing, no statistically significant difference in 3-year overall survival (p=0.998) and progression-free survival rates between the groups has been observed (p=0.893). Eleven patients in the SBTS group and 23 in the ES group received a stoma (p=0.031), with a reversal rate of 30% so far. Our findings indicate that the two treatment strategies are equivalent. No difference in oncologic outcome was found at a median follow-up of 36months. The significantly lower stoma rate noted in the SBTS group argues in favour of the SBTS procedure when performed in expert hands.

Short-term cost-effectiveness of colonic stenting is lost at 90-day follow-up in patients with malignant large bowel obstruction

Short-term cost-effectiveness of colonic stenting is lost at 90-day follow-up in patients with malignant large bowel obstruction

Colonic stenting: When and how

Since the first report in 1990 by Dohomoto et al., endoluminal stenting of the colorectum has become a viable alternative to surgery. For patients with unresectable disease, stent implantation can be considered, avoiding the need for colostomy and has been associated with a better quality of life. The long-term outcomes of palliative stenting has shown favorable results. Emergency surgery in patients with colonic obstruction is associated with significant morbidity and mortality rates. Stenting as bridge to surgery is now an alternative to emergency surgery despite the uncertainity of its long-term oncologic safety. Colonic stenting has been used in benign colonic obstructions but the data on long-term outcomes remains limited. The appropriate decision for stent or surgery in the setting of acute colonic obstruction requires a structured approach.

Colonic stenting: A single centre's 10-year experience

Colonic stenting: A single centre's 10-year experience

Through-the-scope enteral metal stent placement using a short-type single-balloon enteroscope for malignant surgically reconstructed jejunal stenosis (with video).

Self-expandable metal stent (SEMS) placement in surgically reconstructed intestine is technically challenging, and only a few reports have been published.1, 2 Here, we describe a case of successful SEMS placement for surgically reconstructed jejunal stenosis using a newly developed short-type single-balloon enteroscope (sSBE). A 70-year-old man presented to our hospital with fever and jaundice. Six months earlier, he had undergone subtotal stomach-preserving pancreatoduodenectomy with PD-II reconstruction for duodenal cancer. Computed tomography revealed a dilated intrahepatic bile duct as a result of stenosis in the surgically reconstructed jejunal loop caused by cancer recurrence (Fig. 1a). We could reach the stenosis using a sSBE (SIF-H290S; channel diameter, 3.2 mm; Olympus, Tokyo, Japan); however, it was impossible to pass beyond the stenosis (Fig. 1b). Because of the advanced stage of cancer, palliative through-the-scope (TTS) SEMS placement was attempted. A 0.035-inch guidewire was advanced beyond the stenosis, and an uncovered SEMS (18-mm wide, 80-mm long; Niti-S Enteral Colonic Stent; Taewoong Medical, Gimpo, Korea) was deployed (Fig. 2, Video S1). The postoperative period was uneventful. Jaundice and cholangitis resolved in a few days. Abdominal X-ray revealed that the stent was well expanded. The sSBE is compatible with the use of various interventional devices through its large working channel. To date, there is only one report on TTS SEMS placement, but it used a short-type double-balloon enteroscope (DBE).3 In comparison with DBE, SBE was assumed to be more disadvantageous in carrying out deep insertion.4 Having been equipped with a passive bending part, the sSBE has an increased endoscope flexibility. A recent article using sSBE showed its success rate of insertion to the blind end to be 92%.5 Although the safety of SEMS placement in the jejunum is yet to be established, TTS SEMS placement using sSBE could be an effective, minimally invasive treatment option for patients with advanced cancer. Authors declare no conflicts of interest for this article. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Percutaneous colonic stent insertion via a radiologically placed distal ‘cecostomy’ tube for the management of acute malignant bowel obstruction

Percutaneous colonic stent insertion via a radiologically placed distal ‘cecostomy’ tube for the management of acute malignant bowel obstruction

Abstract 3970: Impact of endoscopic stent insertion on detection of viable circulating tumor cells for obstructing colon cancer

Abstract The obstructive colorectal cancer(CRC) was reported to be 7-20% of CRC. For the patients (pts) with obstructive colorectal cancer, self-expanding metallic stents (SEMS) have been useful as a palliative treatment. Insertion of SEMS for obstructive colorectal cancer is used as a bridge to surgery approach. But suspicion have been raised about whether shear forces that act on the tumor during expansion of the stent may result in a release of cancer cells into the circulation (i.e., CTCs). This study was conducted to clarify whether insertion of colonic stents results in increased levels of viable CTCs (v-CTCs). For detecting viable CTCs(v-CTCs) of CRC, we employed a novel method, TelomeScan F35 detection system. The system was constructed with a GFP-expressing attenuated adenovirus, in which the telomerase promoter regulates viral replication. 7.5 ml of peripheral blood samples were obtained before and after stent insertion and after operation. GFP-positive and CD45-negative cells were counted as v- CTCs. This study was a single institution trial, approved by the Kure Medical Center IRB. Surgical operation was scheduled within 1 month after stenting. Between October 2013 and June 2015,10 pts aged 58-89 years (5 males and 5 females) were enrolled. The surgical operation (R0) was performed in 9 cases. CEA was reduced to &amp;lt;50% of baseline value in 6 of 9 measurable pts after resection. 6 pts had no v-CTCs before stenting. Among them, 3 pts had increasing number of 1-3 v-CTCs after stenting and 1 of them developed multiple liver metastasis 12 month after resection. While, 4 pts had v-CTCs (1-19 cells) before stenting and 3 of these 4 patients had significant increase of number of v-CTCs (1-21 cells) after stent insertion. 2 of them had 12 and 14 v-CTCs, respectively after operation, despite the normalized value of CEA. The present study suggested that endoscopic stent insertion may result in tumor cell dissemination into the peripheral circulation and may induce early distant metastasis. In conclusion, v-CTCs may become useful for prognosis assessment, especially when SEMS insertion is considered. Citation Format: Shinya Yamashita. Impact of endoscopic stent insertion on detection of viable circulating tumor cells for obstructing colon cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3970.

Comparison between metallic stent and transanal decompression tube for malignant large-bowel obstruction

BackgroundThe short-term safety and efficacy of a self-expandable metallic colonic stent (SEMS) insertion followed by elective surgery, “bridge to surgery (BTS)”, for malignant large-bowel obstruction (MLBO) have been well described comparing with emergency surgery. The aim of this study was to compare short-term outcomes of endoscopic decompression using a SEMS versus a transanal decompression tube (TDT). Materials and methodsFrom January 2005 to November 2014, a total of 101 patients with MLBO underwent surgery at our single institution were retrospectively identified. Among them, 73 patients who underwent preoperative complete insertion of a decompression device (TDT, n = 45; SEMS, n = 28) were finally included in this study. Six patients with incomplete insertion of a decompression device (TDT, n = 5; SEMS, n = 1) were also excluded. The primary endpoints of this study were the postoperative morbidity and mortality rates. The secondary endpoints were decompression-related outcomes. Additionally, propensity score matched (PSM) analysis was conducted in short-term outcomes between the groups. ResultsThe SEMS group had significantly higher proportion of right-sided tumor and bigger tumor size compared with those of the TDT group. The SEMS group had a significantly higher proportion of patients who underwent laparoscopic surgery, and consequently, a longer surgical duration than did the TDT group. Higher rates of insertion failure and perforation were recognized in the TDT group than in the SEMS group (10.0% versus 3.6% and 8.9% versus 0.0%, respectively), although these differences were not statistically significant (P = 0.406 and 0.291, respectively). The two groups showed similar occurrences of anastomotic leakage, bowel obstruction, overall complications, and mortality. Compared with the TDT group, the SEMS group had a significantly lower rate of surgical site infection (24.4% versus 3.6%, respectively; P = 0.023 and P = 0.025 after PSM) and a shorter length of hospital stay (median, 21 d [interquartile range, 18-29 d] versus 38 d [interquartile range, 28-45 d], respectively; P = 0.015 and P = 0.003 after PSM). Solid food intake after decompression and preoperative temporary discharge occurred only in the SEMS group. ConclusionsPreoperative SEMS insertion for MLBO is effective with at least equivalent short-term outcomes and superior preoperative quality of life compared with decompression using TDT.

Self-expanding metal stenting for obstructing left colon cancer: A district hospital experience.

Stenting of malignant colonic obstructions using self-expanding metal stents (SEMS) is commonly used for palliation and can be used as an interim procedure prior to definitive surgery. We retrospectively reviewed prospectively collected data from all consecutive colonic stenting procedures undertaken between September 2007 and December 2014 at a district general hospital. Technical and clinical success rates, mortality, colonic perforation, and other complications were documented and analyzed. Sixty-four colonic stenting procedures were undertaken. Fifty-three (83%) were for palliation and eleven (17%) were performed as a bridge to definitive surgery. Technical (98.4%) and clinical (89.9%) success rates were excellent. The single documented failure was secondary to complete luminal obstruction. Three stent occlusions (4.6%), one colonic perforation (1.5%), and one migration were encountered. There were no procedure-related deaths. Colonic stenting for obstructing left-sided colon cancer is a safe and effective procedure, even in the district general hospital setting. The use of SEMS as a bridge to elective surgery balances surgical and oncological considerations and, therefore, is most appropriate for high surgical risk patients in this setting.