Efficacy Of Self-expandable Metal Stents Research Articles

Efficacy and safety of self-expandable metallic stents for management of benign gastric outlet obstruction-A prospective study.

We aimed at evaluating the safety and efficacy of self-expandable metallic stent (SEMS) insertion for managing patients with benign gastric outlet obstruction (GOO). This prospective interventional study included 23 patients. All consecutive treatment-naïve symptomatic patients with benign GOO were recruited. Fully covered SEMS were deployed across the stricture under fluoroscopic and endoscopic guidance. Technical success, clinical success and sustained treatment response (STR) were assessed. Technical success was defined as the successful deployment of SEMS at the desired anatomic location. Clinical success was defined as the resolution of symptoms and an increase in Gastric Outlet Obstruction Scoring System (GOOSS) of at least 1 point from the baseline score on Day 7. STR was assessed at four and eightweeks post stent removal in patients who had a response at week four. Factors associated with stent migration and non-response at week four were also assessed. The median age of the study population was 30years (range 19-65years). Males constituted 65.22%. Most patients presented with vomiting (100%) and abdominal pain (95.65%). Peptic stricture was most common etiology for GOO (60.9%) followed by tubercular (26.1%) and corrosive (13%). Most common site of obstruction was junction of first and second part of duodenum (69.57%) followed by pyloric (30.43%). Median length of stricture was 2cm (range 1.5-4). Technical success was achieved in all 23 patients (100%). Clinical success was achieved in 21 patients (91.3%). Response at Day 28 was seen in 20 patients (86.95%). Eighteen of 20 (90%) patients who had a response at week four had STR at week four and week eight after stent removal. Stent migration occurred in five (21.7%) patients. On univariate analysis, stricture length, calibre and stent length were found to predict migration. Fully covered SEMS was an effective and safe management modality in patients with benign GOO. Stent migration remains a troublesome disadvantage.

Efficacy of Oesophageal self expandable metal stent placement for palliation of dysphagia in inoperable oesophageal cancer patients: A low-income country perspective

Efficacy of Oesophageal self expandable metal stent placement for palliation of dysphagia in inoperable oesophageal cancer patients: A low-income country perspective

S1287 Safety and Efficacy of Self-Expandable Metal Stents in Head and Neck Cancer Patients with Radiation-Induced Proximal Esophageal Stricture

S1287 Safety and Efficacy of Self-Expandable Metal Stents in Head and Neck Cancer Patients with Radiation-Induced Proximal Esophageal Stricture

Stenting as a bridge to surgery for extra-colonic malignancy induced colorectal obstruction: preliminary experience

BackgroundThe majority of colonic obstructions result from colorectal cancer. However, malignancies of extra-colonic origin can also disrupt colorectal patency, and the efficacy of self-expanding metal stents (SEMS) insertion as a bridge to surgery in these patients are still in debate. The aim of this study is to evaluate the efficacy of endoscopic stenting as a bridge to surgery (BTS) for extra-colonic malignancy (ECM)-induced colonic obstruction.MethodsThirty-three patients with colonic obstruction due to ECM who received self-expanding metal stents (SEMS) insertion at a single academic tertiary medical center between 2004 and 2015 were included. The purpose of SEMS insertion was determined based on whether the patient’s medical records indicated any surgical plans before SEMS insertion. Technical success was defined as a patent SEMS covering the entire length of the obstruction. Bridging success was defined as elective surgical procedures after the first SEMS insertion.ResultsAmong the 33 patients who underwent SEMS insertion for colorectal obstruction due to ECM, nine underwent SEMS as a BTS. Technical success was achieved in 100% (9/9). Seven patients underwent elective surgery after successful decompression with the first SEMS, and the bridging success rate was 77.8% (7/9). Two patients needed secondary stent insertion before elective surgery. However, none of them required emergent surgery. No major complications occurred, including death related to colorectal endoscopic procedures, perforation, or bleeding.ConclusionSEMS insertion as a BTS is a good treatment option to avoid emergent surgery in patients with colonic obstruction caused by extra-colonic malignancy.

Influence factors of clinical efficacy of self-expanding metallic stents in treatment of colorectal cancer obstruction

Objective To analyze the clinical efficacy and relative influence factors of self-expanding metallic stents (SEMS) in treating colorectal cancer obstruction. Methods Information of 47 patients received SEMS to treat colorectal cancer obstruction from Mar. 2012 to Dec. 2017 in Beijing Haidian Hospital were collected, who were then followed up in outpatient or by telephone. Effective rate, survival rate and complications were recorded and calculated by the software of SPSS 17.0. Chi-square test was used to analyze relative influence factors. Results Results shown that the clinical efficacy was 100%(47/47). Patients′ 30-day survival rate and 6-month survival rate were 87.2% (41/47) and 68.1% (32/47), respectively. After surgery, 2 patients presented with perforation, 3 patients presented with migration and 5 patients presented with reobstruction. Clinical stage of tumor and stent length were related with complications and survival. Therein, complications presented more in patients with advanced cancer. And the longer stent length, the higher mortality. Conclusions Clinical stage of tumor and stent length maybe risk factors of complications and survival of patients after SEMS surgery of colorectal cancer obstruction. Key words: Stents; Intestinal obstruction; Colorectal neoplasms; Efficacy; Survival rate; Influence factors

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

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

Safety and efficacy of self-expanding metal stents for biliary drainage in patients receiving neoadjuvant therapy for pancreatic cancer.

Background and study aims Durable biliary drainage is essential during neoadjuvant therapy (NAT) in patients with pancreatic cancer who present with biliary obstruction. Plastic stents (PS) tend to occlude readily, resulting in delay/interruption of treatment. Our aim was to evaluate the safety and efficacy of self-expanding metal stents (SEMS) for biliary drainage in patients receiving NAT for pancreatic cancer. Patients and methods From 2009 to 2014, all consecutive patients with resectable pancreatic cancer at one tertiary center had SEMS placed for biliary drainage before NAT was started. Data on biliary drainage efficacy, stent malfunction rates and procedural adverse events were collected. Results One hundred forty-two consecutive patients with pancreatic cancer (mean age 66 ± 9 SD years; 81 male, 61 female; 67 resectable, 75 borderline resectable) were enrolled. Eight-seven patients (61 %) had prior PS exchanged to SEMS and 55 (39 %) had SEMS placed upfront. Median duration from SEMS placement to the end of NAT/surgery was 111 days (range 44 – 282). During NAT, SEMS malfunction requiring reintervention occurred in 16 patients (11.2 %): tissue ingrowth 11, stent occlusion from food 6, stent migration 3, incomplete expansion 1, “tissue cheese-cutter” effect 1, and cystic duct obstruction 1. On subgroup analysis, no correlation between SEMS malfunction and stage of disease, prior PS, or duration of NAT was found (r 2 = 0.05, P = 0.34). Presence of SEMS in situ did not affect pancreaticoduodenectomy. Conclusion SEMS provide safe, effective and durable biliary drainage during NAT for pancreas cancer. Previously placed PS can be exchanged for SEMS. SEMS do not require removal prior to surgery.

The utility and efficacy of self-expandable metal stents for treating malignant gastric outlet obstructions in patients under best supportive care.

Self-expandable metallic stents (SEMSs) may be used to effectively palliate malignant gastric outlet obstructions (GOOs), but their utility and efficacy in patients under best supportive care (BSC) have not been explored. In this multicenter retrospective study, we reviewed data on patients under BSC who underwent endoscopic SEMS placement to treat malignant GOO without chemotherapy. We evaluated the safety and efficacy of the procedure. We enrolled a total of 208 patients. SEMS placement was technically successful in 207 (99.5%) and clinically successful in 164 (78.8%). The mean procedure time was 25.6 ± 2.8min. Stent dysfunction later developed in 30 (14.4%) patients, of whom 90% (27/30) underwent reintervention. The procedure-related mortality rate was 1.44%; all deaths were due to pneumonia. Subgroup analysis by Karnofsky performance status (KPS) revealed that neither technical success, stent dysfunction, reintervention rate, procedure-related pneumonia or death, nor death within 14days differed between patients with good and poor KPS. However, the clinical success rate and the median survival time were significantly lower and shorter, respectively, in those with poor KPS (p < 0.001). Duodenal SEMS placement is an effective palliative treatment for malignant GOO in BSC patients. Although the GOO score did not dramatically improve in patients with poor KPS, the procedure was safe and palliatively feasible. Procedure-related pneumonia was fatal; thus, it is essential to proceed with great caution. Clinical trial registration number: UMIN000028367.

Clinical outcomes following self-expanding metal stent placement for esophageal salvage

ObjectivesTo assess the efficacy of self-expanding metal stents (SEMS) for esophageal salvage in patients who would otherwise require esophageal/conduit resection. MethodsWe performed a retrospective chart review of patients who had SEMS placed from January 2010 to December 2015. Patient demographics, esophageal stent characteristics, and outcomes were assessed in our patient cohort. ResultsOur study included a total of 83 patients. A total of 148 SEMS were placed, with 121 partially covered SEMS (pcSEMS) and 27 fully covered SEMS (cSEMS). A stent was placed more than once in 42.2% of the patients. Median duration of stent placement was 23 days. Indications for SEMS placement included esophageal leak after esophageal resection (45.8%), spontaneous esophageal perforation (22.9%), iatrogenic esophageal perforation (20.5%), and esophageal obstruction (9.6%). Complications from SEMS placement included 6 stent migrations and 1 esophageal perforation. Of the 6 stents that migrated, 2 were pcSEMS and 4 were cSEMS. In a patient who underwent stent placement for a stricture refractory to dilation, a perforation at the distal end was discovered 2 days after stent removal. The perforation healed after the second SEMS placement. Ultimately, 15 patients (18.1%) had to undergo a subsequent esophagectomy or takedown of their conduit with an overall 81.9% salvage of native esophagus or conduits. ConclusionsOur study demonstrates the successful use of SEMS in patients with anastomotic leaks, perforations, and recalcitrant strictures.

Safety and efficacy of self-expandable metal stents for obstructive proximal and distal large bowel cancer.

Self-expandable metal stents are often used to treat obstructive large bowel cancers. This study assessed the safety and efficacy of colonic stent insertion carried out in a district general hospital. Methods A retrospective review was carried out between 1 January 2007 and 28 February 2014 to identify patients who underwent stent insertion for malignant colorectal obstruction. Results Seventy-five patients (median age 75.2 years, 70.6% male) with primary colorectal cancer underwent stent insertion - 53 underwent semi-elective self-expanded metal stent insertion (for subacute bowel obstruction) and 22 had emergency stent inserted (for acute bowel obstruction). The majority (88%) had self-expanded metal stents inserted for palliation. Technical and clinical success rates were 98.7% and 91.2%, respectively. One patient had stent-related perforation; there was no procedure-related mortality. Conclusion This study shows that self-expanded metal stent insertion in malignant colorectal obstruction is safe and effective and can be successfully delivered in a district general hospital with high technical and clinical success rates.

Safety and Efficacy of Self-Expanding Metal Stents for Biliary Drainage in Patients Receiving Neoadjuvant Therapy for Pancreatic Cancer

Introduction: Durable biliary drainage is essential during neoadjuvant therapy (NAT) in patients with biliary obstruction from pancreas cancer. Plastic stents (PS) are associated with high occlusion rates resulting in interruptions in treatment. The aim of this study was to evaluate the safety and efficacy of self-expanding metal stents (SEMS) for biliary drainage in patients receiving NAT for pancreatic cancer. Methods: All patients referred to a tertiary center with resectable or borderline resectable (BR) pancreatic cancer and biliary obstruction were retrospectively reviewed using a prospectively maintained database. After confirming the diagnosis with EUS-FNA (on site), SEMS were deployed either as the initial biliary intervention or at the time of stent exchange in those who had prior PS. All patients who received NAT after SEMS placement were enrolled. Demographics, biliary drainage efficacy, stent dysfunction rate, procedural complications and SEMS-related reinterventions were collected. Results: From 2009 to 2014, 333 consecutive patients with resectable or BR pancreatic cancer were reviewed. Biliary drainage was required in 210 patients of which 142 (81 M, mean age 66 ± 9 years) had SEMS placed prior to starting NAT. Sixty-seven (47%) were resectable, 75 (53%) BR, 87 (61%) had prior PS exchanged to SEMS, and 115 (81%) were uncovered SEMS. The median duration from SEMS placement to the end of NAT was 111 days (range 44-282, Figure 1).Figure 1Liver function tests improved significantly after SEMS (Table 1). During NAT (median 111 days), SEMS dysfunction requiring reintervention occurred in 16 patients (11.2%) and by 282 days (maximum range of NAT) in 21 patients (14.8%;Figure 1): tissue/tumor ingrowth (11), stent occlusion from debris/food (6), stent migration (3), incomplete expansion (1), “tissue cheese-cutter” effect (1) and cystic duct obstruction (1). No difference in the rate of stent dysfunction and reinterventions was found on subgroup analysis (Table 2). There was no significant correlation between the days to SEMS related reinterventions and the duration of NAT (r2=0.05, p=0.34).Table 1: Liver function tests and tumor markers pre and post SEMS placementTable 2: Subgroup analysisConclusion: SEMS provide safe, effective and durable biliary drainage during NAT for pancreas cancer. No predictors of stent dysfunction requiring reintervention were found and there was no correlation between the duration of neoadjuvant therapy and SEMS dysfunction rate.

Systematic review with meta-analysis: self-expanding metal stents in patients with cirrhosis and severe or refractory oesophageal variceal bleeding.

The prognosis of patients with cirrhosis and acute variceal bleeding is very poor when the standard-of-care fails to control bleeding. New treatment modalities are needed in these patients. To synthesise the available evidence on the efficacy of self-expanding metal stents (SEMS) in patients with cirrhosis and severe or refractory oesophageal variceal bleeding. Meta-analysis of trials evaluating SEMS in patients with cirrhosis and severe or refractory oesophageal variceal bleeding. Thirteen studies were included. The pooled estimate rates were 0.40 (95% confidence interval, CI=0.31-0.49) for death, 0.41 (95% CI=0.29-0.53) for liver-related death and 0.36 (95% CI=0.26-0.47) for death at day 30, with low heterogeneity between studies. The pooled estimate rates were 0.12 (95% CI=0.07-0.21) for mortality related to variceal bleeding, and 0.18 (95% CI=0.11-0.29) for failure to control bleeding with SEMS, with no or low heterogeneity between studies. The pooled estimate rate were 0.16 (95% CI=0.04-0.48) for rebleeding after stent removal and 0.28 (95% CI=0.17-0.43) for stent migration, with high heterogeneity. A significant proportion of patients had access to liver transplantation or to TIPSS [pooled estimate rate 0.10 (95% CI=0.04-0.21) and 0.26 (95% CI=0.18-0.36), respectively]. Fewer than 40% of patients treated with SEMS were dead at 1month. SEMS can be used as a bridge to TIPSS or to liver transplantation in a significant proportion of patients. Additional studies are required to identify potential risk factors leading to a poor prognosis in patients with acute variceal bleeding in whom the use of SEMS could be considered.

Use of Self-Expanding Metallic Ureteral Stents in the Secondary Treatment of Ureteral Stenosis Following Kidney Transplantation.

To evaluate the safety and efficacy of self-expanding metal stents in the treatment of ureteral stenosis following kidney transplantation. Seven patients who developed benign stenosis after kidney transplantation were treated by a self-expanding metallic stent implantation from June 2007 to March 2014. All patients had undergone at least one open surgical procedure and one endourologic procedure for treatment of the stenosis. The extent of stenosis varied from 1.2 to 3.7 cm. Ultrasonography, urography, diuretic renography, and urine culture were performed every 3 months after stent insertion. Ureteroscopic examination was performed when needed. Stent placement was technically effective in all cases. The mean operative time was 37 minutes (range, 26-59 minutes). Lower urinary-tract symptoms and the ipsilateral flank pain were common early-stage complications and were greatly relieved after an average of 3 months. The mean follow-up duration was 38 months (range, 13-86 months), and no stent migration or fragmentation was observed. Urothelial hyperplasia occurred in only one patient and was effectively managed with a Double-J stent. Five patients had normal stable renal function; the remaining two had impaired renal function, including one patient with a preoperative renal failure who required dialysis at the end of the follow-up period (36 months). As an alternative to open surgery, implantation of a self-expanding metal stent is a safe and effective treatment for ureteral stenosis in patients who have undergone kidney transplantation.

大腸癌イレウス症例に対する自己拡張型金属ステントの有用性

大腸癌イレウス症例に対する自己拡張型金属ステントの有用性

The role of primary colectomy after successful endoscopic stenting in patients with obstructive metastatic colorectal cancer.

Although the initial clinical efficacy of self-expandable metal stents is acceptable, doubt still remains about long-term clinical outcomes and complications. The aim of this study was to evaluate the stoma formation rate and risk factors for complications after successful stenting in patients with obstructive metastatic colorectal cancer. This was a tertiary-care center retrospective study. From January 2000 to December 2010, 130 patients with unresectable obstructive colorectal cancer received successful self-expandable metal stent placement. Among them, 14 patients received primary colectomy after successful stenting. Self-expandable metal stent placement and primary colectomy were performed. The stoma formation rate and complications were measured. In patients with successful stenting, stoma formation rates at 1 and 2 years were 15.6% (95% CI, 8.74-22.4) and 24.4% (95% CI, 13.8-35.0), and the median patency duration was 157 days (range, 2-1590 days). However, long-term complications occurred in 58 patients (44.6%), including reobstruction (32.6%), stent migration (10.3%), and perforation (7.8%), and a large number of reinterventions (45.7%) and hospitalizations (37/9%) were needed to manage complications. In multivariate analysis, primary colectomy after successful endoscopic stenting was a negative predictive factor for reobstruction (OR, 0.12; 95% CI, 0.02-0.99; p = 0.04). This was a retrospective, single-center study. To reduce stent-related late complications, primary colectomy after successful endoscopic stenting could be a therapeutic option in patients who have unresectable colorectal cancer with obstruction, especially in those who expect long-term survival.

The Efficacy of Self-Expanding Metal Stents for Malignant Colorectal Obstruction by Noncolonic Malignancy with Peritoneal Carcinomatosis

Although self-expanding metal stents for colorectal obstruction is preferred over emergency surgery, the efficacy of self-expanding metal stents in patients with malignant colorectal obstruction by a noncolonic malignancy with peritoneal carcinomatosis has not been demonstrated. The aim of this study was to evaluate the survival and long-term clinical outcome of self-expanding metal stents as the initial interventional approach in patients with malignant colorectal obstruction due to a noncolonic malignancy with peritoneal carcinomatosis. This is a retrospective study. This study was conducted at 2 tertiary care academic medical centers in South Korea. The patients were included who underwent self-expanding metal stent insertion for palliation of a malignant colorectal obstruction by a noncolonic malignancy with peritoneal carcinomatosis between July 2004 and January 2010. Inclusion criteria were incurable status, noncolorectal cancer, obstructive symptoms and/or signs, and colonoscopic findings of obstruction. The survival and success rate of patients undergoing self-expanding metal stents insertion was assessed. Twenty patients were included during the study period. Technical success of self-expanding metal stents was achieved in 18/20 (90.0%) patients, and obstructive symptoms were resolved within 72 hours in 17/20 (85.0%) patients. Ten patients (10/20, 50%) did not need further intervention during the follow-up period after the first stent insertion. Eight patients ultimately underwent surgery during the follow-up period. One of the remaining 2 patients underwent additional endoscopic treatment without surgery. Another patient refused further intervention and thus received conservative management. Mean event-free survival was 119.0 days, and the mean overall survival of the included patients was 156.3 days. The number of study patients was small. Self-expanding metal stent insertion appears to be a reasonable first-treatment option in patients with malignant colorectal obstruction by noncolonic malignancy with peritoneal carcinomatosis.

The Efficacy of Self-Expanding Metal Stents for Colorectal Obstruction with Unresectable Stage IVB Colorectal Cancer

Acute colorectal obstruction with stage IVB colorectal cancer has a poor prognosis and short life expectancy. The effectiveness of self-expanding metal stents (SEMS) has been demonstrated in colorectal cancer patients with obstruction. However, little is known about the palliative efficacy of stent placement inpatients with unresectable colorectal cancer. The medical records of patients who received SEMS for stage IVB colorectal cancer with acute colorectal obstruction between March 2004 and July 2010 were retrospectively reviewed. A total of 24 patients with unresectable Stage IVB colorectal cancer with acute colorectal obstruction were enrolled in this study. Twenty-four patients received SEMS placement during the study period. The mean age of the patients was 63.0 years (range 35-84 years). Fifteen patients were male and nine were female. The most common obstructive lesion was in the sigmoid colon (70.8%), including the sigmoid-descending and rectosigmoid junctions. Un-covered SEMS were used in 62.5% of patients. On the first attempt, the technical success rate of SEMS was 95.8%. The estimated duration of primary stent patency and overall survival periods after SEMS were 332.0 and 231.8 days, respectively. SEMS insertion may be a useful therapeutic choice for acute colorectal obstruction in patients with unresectable stage IVB colorectal cancer.

Mo1398 The Efficacy of Self-Expanding Metal Stents for Peritoneal Carcinomatosis Related Malignant Colorectal Obstruction

Mo1398 The Efficacy of Self-Expanding Metal Stents for Peritoneal Carcinomatosis Related Malignant Colorectal Obstruction

The efficacy of self-expanding metallic stents in the palliation of patients with advanced esophageal cancer

The efficacy of self-expanding metallic stents in the palliation of patients with advanced esophageal cancer

Endoscopic Palliation in Patients With Incurable Malignant Colorectal Obstruction by Means of Self-expanding Metal Stent

To evaluate the short- and long-term efficacy of self-expanding metal stents (SEMSs) in patients with colorectal obstruction and incurable cancer and the related factors that affect outcomes. Retrospective analysis of SEMS placement for incurable colorectal obstruction in a 3-year period. Five tertiary care endoscopic centers. Consecutive patients (N = 201) undergoing stenting for incurable malignant obstruction. Clinical and technical success of stenting, complications rate, and factors affecting outcomes. Technical success was achieved in 184 of 201 patients (91.5%) and clinical success occurred in 165 of 184 patients (89.7%; 82.1% of 201 patients). Technical and clinical failures were more frequent in extrinsic and long colorectal stenoses. Overall, 165 patients had normal bowel movements during follow-up (mean [SD], 115.5 [100.3] days; range, 1-500 days), 15 developed complications, 127 had a functioning SEMS at the time of death, and 23 were alive at completion of the study. Twenty-four (11.9%) major complications occurred: 11 migrations, 12 perforations, and 1 reobstruction. Migration of SEMSs was associated with stent diameter less than 25 mm. Bevacizumab therapy increased the risk of perforation by 19.6-fold. Karnofsky performance status of 50 or less was associated with shorter survival and a 3.7-fold higher risk of death within 6 months after the stent was placed. The use of SEMSs is safe and effective for palliation of incurable malignant colonic obstruction; approximately 75% of patients with SEMSs are able to avoid colostomy.