Palliative Stenting Research Articles

OGC SO36 - Complications of palliative oesophageal cancer stent insertion: Audit for a five year period

Abstract Background Oesophageal stents are commonly used for the palliative treatment of inoperable oesophageal malignancy[1]. Stenting of the oesophagus may provide safe and quickly effective management for late-stage disease symptoms. However, there are common complications associated with the oesophageal stents. This audit looks at the types of early and delayed complications from oesophageal stenting, specifically for malignancy. We aim to stratify the types of complication, association between complications and the type of stent used, and the frequency of repeat stenting or repositioning. This will provide patients with better expectations of the complications and compare our practice against published international standards Method All fluoroscopy guided stent insertions between 1/1/2019 and 31/12/2023 for oesophageal malignancy were requested from the hospital radiology department. 101 patients were included for analysis. Their basic demographics were obtained, as well as a disease profile including tumour histology, staging and whether they underwent radiotherapy or chemotherapy. Complications of the stent insertion were then logged. The number of times stents were replaced or repositioned were noted. The type of stent, size parameters, features such as covering, antimigration device and anti-reflux valve were also assessed. In addition, any hospital admissions related to stent complications were also recorded. Results Of 101 patients, the median age was 75, with a higher proportion of male patients ( 71%). After stent fitting there was a median survival length of 94 days. 45% of patients had complications related to the stent. Stent migration was the most frequent complication, 14% of patients experienced stent migration into the stomach, which required repositioning or restenting. Both middle and lower oesophagus stents had equal complication rate. 25% of patients were reported to have overgrowth of tumour affecting the stent, and there was no significant difference in those fitted with a covered stent, meant to reduce overgrowth complications. Conclusion The complications directly resulting from oesophageal stents may adversely affect the palliation of oesophageal cancer patients. In this cohort, the most commonly occurring complications were migration of the stent, immediate symptoms after insertion, and overgrowth of the tumour. Although overgrowth of tumour is part of the disease progression, in many cases it made retrieval of the existing stent or reinsertion more difficult. Our results found no significant difference for complication rates between the different stents, nor the inclusion of antimigration devices. There were no deaths directly due to the stent and no oesophageal perforations reported.

Hemodynamics in the treatment of pseudoaneurysm caused by extreme constriction of aortic arch with coated stent.

To evaluate the changes in distal vascular morphology and hemodynamics in patients with extremely severe aortic coarctation (CoA) after covered palliative (CP) stent dilation with different surgical strategies. Perioperative computed tomography angiography and digital subtraction angiography were utilized to construct three aortic models with varying stenosis rates and one follow-up model in a patient with extremely severe CoA. The models included: an idealized non-stenosed model (A: 0%), a model post initial stent deployment (B: 28%), a model post balloon expansion (C: 39%), and a model 18 months after post-balloon expansion (D: 39%). Consistent boundary conditions were applied to all models, and hemodynamic simulation was conducted using the pure fluid method. The narrowest and distal diameter of the stent increased by 34.71% and 59.29%, respectively, from model B to C. Additionally, the distal diameter of the stent increased by -13.80% and +43.68% compared to the descending aorta diameter, respectively. Furthermore, the ellipticity of the maximum cross-section of the aneurysm region in model A to D continued to increase. The oscillatory shear index at the stenosis to the region of the aneurysm were found to be higher in Models A and B, and lower in Models C and D. At the moment of maximum flow velocity, the blood flow distribution in models A and B was more uniform in the widest section of the blood vessels at the distal end of the stenosis, whereas models C and D exhibited disturbed blood flow with more than 2 eddy currents. The time-averaged wall shear stress (TAWSS) decreased in the distal and basal aneurysms, while it significantly increased at the step position. The aneurysmal region exhibited an endothelial cell activation potential value lower than 0.4 Pa-1. In patients with extremely severe CoA, it is crucial to ensure that the expanded diameter at both ends of the CP stent does not exceed the native vascular diameter during deployment. Our simulation results demonstrate that overdilation leads to a decrease in the TAWSS above the injured vessel, creating an abnormal hemodynamic environment that may contribute to the development and enlargement of false aneurysms in the early postoperative period. ClinicalTrials.gov, (NCT02917980).

Surgical treatment of a newborn with critical aortic coarctation using palliative stenting: a case report

Introduction. Coarctation of the aorta (CoA) is a congenital severe narrowing of the aortic isthmus, which in turn is often accompanied by impaired organ perfusion or even cardiogenic shock. In newborns with critical CoA in the case of patent ductus arteriosus (PDA) closure, the clinical condition of patients with this congenital heart defect (CHD) sharply worsens and leads to multiple organ failure. In this group of children, mortality ranges from 30 to 50% of infant mortality from CHD. This case demonstrates the positive effect of palliative stenting of a narrowed section of the aorta, which made it possible to safely perform radical surgery for CHD.Case description. Nine-year-old male patient with body weight of 3,5 kg and body length of 53 cm was admitted to the clinic with a diagnosis of CHD: Critical CoA. Secundum atrial septal defect. PDA. Multiple organ failure. Taking into account the severe comorbidity status in the form of multiple organ failure, the high risk of necrotizing enterocolitis, case conference decided to perform a step-by-step CHD treatment as follows: palliative endovascular stenting of critical CoA, followed by radical surgery after stabilization of the patient's condition. The plan was successfully implemented.Conclusion. Сritical CoA stenting can be used as a bridge to radical surgery of the defect in newborns with multiple organ failure. This palliative intervention helps to stabilize the child for up to 3 weeks and more safely perform radical surgery of CoA.

Palliative Right Ventricular Outflow Tract Stenting in Tetralogy of Fallot with Severe Cyanosis: Experience from a Single Center in Southern India

Background: This study conducted at an Indian tertiary care hospital aimed to characterize the clinical profile of tetralogy of Fallot (ToF) patients undergoing right ventricular outflow tract (RVOT) stenting and assess their immediate postprocedural outcomes until discharge. Methods: In this retrospective analysis, the clinical and procedural outcomes were analyzed for 20 patients who underwent palliative stenting in the RVOT for severe cyanosis associated with ToF during 2021–2023. Results: The median age for the patients was 2.3 years (range 3 months–21 years), two being adults (>18 years). Fourteen (70%) patients underwent elective RVOT stent and 30% underwent emergency stenting. The most common indication of RVOT stenting was hypoplastic branch pulmonary arteries (PAs) (n = 11, 78.6%) and cyanotic spell (n = 4, 66.7%) for elective and emergency surgeries, respectively. The average improvement in SpO2 was 27.2% (95% confidence interval 23.4–31.0, P < 0.001). Six (30%) patients had complications including reperfusion injury of lungs (n = 2, 33.4%) sepsis (n = 1, 16.7%), stent embolization (n = 1, 16.7%), re-stenting (n = 1, 16.7%), transient complete heart block (n = 1, 16.7%) during the procedure, and. One child went through RVOT stent postoperative due to severe residual stenosis and child developed severe tricuspid regurgitation and succumbed to death due to culture positive sepsis with multi-organ dysfunction. Rest (n = 19, 95%) were discharged with an average 6.7 days of hospital stay. Conclusion: ROVT stenting is a safe and effective palliative management in ToF enhancing oxygen saturation prior to definitive surgical repair.

Esophageal Melanoma - A Rare Neoplasm

A 70 year old man having progressive dysphagia, coronary artery disease (CAD) with an Ejection Fraction (EF) of 30% was detected to have a poorly differentiated esophageal malignancy. Immunohistochemistry (IHC) was positive for HMB 45 and SOX 10 confirming esophageal melanoma. In view of advanced age and poor cardiac function, surgical treatment was not feasible. Palliative esophageal metallic stenting was performed. Immunotherapy was suggested with ICI. We present this case in view of rarity of esophageal melanoma and to stress the need for evaluation with IHC in subjects with poorly differentiated esophageal malignancy.

NEW ONSET OF PULMONARY HYPERTENSION IN A PATIENT AFFECTED BY RECURRENT LUNG CANCER

Abstract 39 years old non–smoker female patient came to our observation in July 2023 complaining dyspnea on mild exertion. She had a history of lung adenocarcinoma with epidermal growth factor receptor (EGFR) positive for exon 19 deletion treated with left pneumonectomy and ipsilateral hilar mediastinal lymphadenectomy 5 years earlier, and contralateral disease progression currently treated with chemotherapy. Transthoracic echocardiogram showed circumferential prepericardial effusion requiring pericardiocentesis with transient clinical benefit. Indeed, after a month, she presented with worsening dyspnea and echocardiographic evidence of dilated and hypokinetic right ventricle and severe pulmonary hypertension associated with distal right pulmonary artery stenosis secondary to extrinsic compression by the neoplastic mass as shown by the chest CT scan (fig 1). A right heart catheterization confirmed this finding (minimum diameter of right pulmonary artery of 6 mm, maximum systolic pulmonary blood pressure of 99 mmHg) and a palliative stenting of the distal portion of the right pulmonary artery was performed with resolution of the stenosis, reduction of the pulmonary gradient (fig 2 and 3) and resolution of the dyspnea.

The Current Strategy in Managing Congenital and Structural Heart Disease: Find and Treat Them Appropriately

Significant progress has been made in diagnosing and treating congenital heart defects (CHDs) over the past five decades. Notable advancements include pulse oximetry screening for critical CHDs in newborns and percutaneous, catheter-based procedures, improving outcomes even in developing nations. Recent studies demonstrate favorable outcomes with device closure of acyanotic CHDs, with non-fluoroscopy techniques adopted to minimize radiation risks. Positive results are observed with right ventricular outflow tract (RVOT) stent palliation for late-presenting cyanotic congenital heart diseases such as tetralogy of Fallot (TOF). Novel interventions like reverse Potts shunt anastomosis show promise in managing pediatric pulmonary arterial hypertension (PAH), while prophylactic treatments effectively reduce postoperative arrhythmias. Fontan procedure significantly enhances survival rates for individuals with single functional ventricles, although challenges arise with aging populations. In developed countries, fetal cardiac interventions utilizing advanced imaging techniques allow for early detection and preventive interventions, reducing secondary complications. Keyword: Fetal Intervention, Fontan, Non-Fluoroscopy, Percutaneous, Reverse Potts, Rheumatic Heart Disease, RVOT Stenting.

Results of Palliative Stenting in Malignant Superior Vena Cava Syndrome Analyzing Self-Expanding Stainless Steel and Nitinol Venous Bare Metal Stents.

The purpose was to analyze the technical, clinical, and survival outcomes of our patients with malignant superior cava vein syndrome (SVCS) treated with endovascular approach and analyze the efficacy of different stent types used. It is an observational, retrospective, single-center study. From 2006 to 2023, 42 patients (32 male, 10 female, mean age 62 years, age range, 41-87 years) underwent percutaneous stent placement for malignant SVCS. One stainless steel stent (Wallstent) and 2 venous nitinol stent type (Sinus-XL, Venovo) were used. Follow-up mean was 276 days. A total of 53 stents were deployed. Clinical success was 97.6% in less 24 hours. Technical success was achieved in 97.6%. No complications were found except 1 patient died during the procedure due to stent migration and atrial dissociation (2.3%). Overall intraprocedural stent migration rate was 11.9% (18.8% stainless steel stent, 9.6% nitinol stent, p>0.05). Overall survival rates were 87.8%, 41.99%, and 34.12%, and overall primary patency rates were 100%, 93.3%, 91.6% at 1, 6, and 12 months, respectively. Endovascular treatment is a safe and effective therapeutic option for SVCS with high technical and clinical success rates and low complication and recurrence rates. The malignant superior cava vein syndrome is a rare clinical entity treated classically with radiation and chemotherapy with a slower response, or surgical bypass, which is an aggressive surgical technique. Endovascular treatment offers a low-invasive technique with quick clinical resolution and good permeability results. However, further studies are lacking to deal with procedure technical characteristics, stent type used, technical complications, and medium- and long-term patency studies. This study aims to evaluate all these items, analysing self-expanding stainless steel and nitinol venous bare metal stents, and add value to endovascular treatment, confirming the good results of this technique.

Overcoming tight perihilar malignant biliary obstructions during percutaneous biliary intervention in Nigerian patients: case reports

BackgroundA major challenge of either endoscopic or percutaneous approach to placing palliative biliary stents is the difficulty in traversing tight perihilar malignant obstructions. This can be overcome with a rendezvous approach (combined endoscopic retrograde cholangiopancreatography (ERCP)/percutaneous approach) or may require initial placement of an external drain and reattempting later. Interventional radiology for biliary obstruction is still in infant days in our locality. Herein, we describe two cases of perihilar malignant biliary obstruction (MBO) managed at a private facility in Lagos, Nigeria, in which we had to come up with a creative approach to crossing these tight junctions in the absence of ERCP facilities. This was done by securing percutaneous retrograde access into the common bile duct and combining it with the initially unsuccessful anterograde approach. In both cases, this combined percutaneous anterograde/retrograde approach resulted in successful traversal of the malignant obstruction and placement of internal biliary stents.Case presentationWe present the case of two elderly patients with tight malignant biliary obstruction (MBO), one from a suspected cholangiocarcinoma and the other from hepatic metastatic colorectal carcinoma. Both patients had successful traversal of the obstruction via a combined percutaneous anterograde/retrograde approach and biliary stenting.ConclusionsOur case reports demonstrate an unusual approach that should assist interventional radiologists in resource-limited setting who seek for a viable option to those presently available for traversing perihilar MBOs in the percutaneous placement of internal stents.

Endoscopic-ultrasound-guided biliary drainage with placement of electrocautery-enhanced lumen-apposing metal stent for palliation of malignant biliary obstruction: Updated meta-analysis.

Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced (ECE) delivery of lumen-apposing metal stent (LAMS) is gradually being recognized as a viable palliative technique for malignant biliary obstruction after endoscopic retrograde cholangiopancreatography (ERCP) failure. However, most of the studies that have assessed its efficacy and safety were small and heterogeneous. Prior meta-analyses of six or fewer studies that were published 2 years ago were therefore underpowered to yield convincing evidence. To update the efficacy and safety of ECE-LAMS for treatment of biliary obstruction after ERCP failure. We searched PubMed, EMBASE, and Scopus databases from the inception of the ECE technique to May 13, 2022. Primary outcome measure was pooled technical success rate, and secondary outcomes were pooled rates of clinical success, reintervention, and adverse events. Meta-analysis was performed using a random-effects model following Freeman-Tukey double-arcsine transformation in R software (version 4.1.3). Fourteen eligible studies involving 620 participants were ultimately included. The pooled rate of technical success was 96.7%, and clinical success was 91.0%. Adverse events were reported in 17.5% of patients. Overall reintervention rate was 7.3%. Subgroup analyses showed results were generally consistent. ECE-LAMS has favorable success with acceptable adverse events in relieving biliary obstruction when ERCP is impossible. The consistency of results across most subgroups suggested that this is a generalizable approach.

O114: Enhancing palliative oesophageal cancer treatment pathway prediction and prognostication through machine learning models

Abstract Introduction Non-curative treatment plans comprise the majority of Oesophageal Cancer (OC) decision-making by Multidisciplinary Teams (MDTs), operating under significant caseload pressures. Machine Learning (ML) can semi-automate, streamline, and standardise these decisions to predict treatments and prognosticate for new patients. We present ML models which predict treatment decisions and prognostication in palliative OC patients. Methods Using clinicopathological data from 437 palliative OC cases treated at a single tertiary centre over 12 years, we trained several ML algorithms (Multinomial Logistic Regression [MLR], Random Forests [RF], Extreme Gradient Boost [XGB], Decision Tree [DT], and Random Survival Forests [RSF]) to predict treatment pathways (best supportive care, chemotherapy, radiotherapy, palliative stent, or stent plus oncological adjunct) and survival prognoses. Model performance was evaluated using Area Under the Curve (AUC) for classifier models and C-index (1-concordance) along with calibration plots for the survival model. Additionally, the models were integrated into a web application for clinician-friendly usability. Results Mean AUCs for the classifier models were: MLR 0.801±0.090, RF 0.806±0.078, XGB 0.817±0.079 and DT 0.762±0.108. Mean C-Index for the RSF survival model was 0.330±0.018 while calibration curves showed good calibration within the first 6-12months (median survival for the cohort was 6.31 months (range 0.1-105.8 months)). Conclusion This study is the first use of ML to predict palliative treatment plans and offer prognostication for OC patients, seamlessly integrated into a user-friendly interface for real-time treatment pathway prediction. This offers significant potential to streamline MDT caseload and provide data-driven decision-support for clinicians counselling these patients.

Multisegmented esophageal fully covered self-expandable metal stent for palliation of malignant dysphagia: a prospective, multicenter feasibility and safety study

A novel multisegmented esophageal fully covered self-expandable metal stent (FCSEMS) was designed to reduce stent migration, which is seen in up to 30% of patients. The goal of this study was to evaluate the safety and efficacy of the multisegmented FCSEMS. This multicenter prospective study aimed to include 30 patients undergoing palliative stent placement. Efficacy, defined as technically successful stent placement and dysphagia scores, and safety, defined as the number of adverse events (AEs) and serious AEs (SAEs), were measured. The study was prematurely terminated due to safety concerns after including 23 patients (mean ± standard deviation age, 72 ± 10 years; 78% male). Stent placement was technically successful in 21 patients (91%), and dysphagia scores had improved in all patients with successful stent placement. SAEs were reported in 16 (70%) patients. Stent-related mortality occurred in 3 patients (13%). The multisegmented FCSEMS successfully treated malignant dysphagia. The study was prematurely terminated, however, because stent placement was associated with a relatively high SAE rate. (Clinical trial registration number: NCT04415463.).

Right ventricular outflow tract stenting for late presenter unrepaired Fallot physiology: a single-center experience.

The purpose of this study was to assess the clinical outcome after right ventricular outflow tract (RVOT) stenting in late presenter patient with unrepaired Fallot physiology. In younger patients, RVOT stenting is an alternative to mBTT shunt; however, there have been few reports of this palliative technique in late presenter population, including adults. This was a single-center, retrospective study of nonrandomized, palliated Fallot patients. Clinical outcomes such as left ventricular ejection fraction and saturation were measured in 32 individuals following RVOT stenting in adults (n = 10) and children (n = 22). The Statistical Package for Social Science (SPSS) 26.0 software was used to analyze the statistical data. During the procedure, the average stent diameter and length were 8.84 ± 1.64 mm and 35.46 ± 11.23 mm, respectively. Adult patients received slightly longer stents than pediatric patients (43.60 ± 11.64 mm vs. 31.77 ± 9.07 mm). Overall, patients' saturation increased from 58.56 ± 19.03% to 91.03 ± 8.98% (p < 0.001), as did their left ventricular ejection fraction (LVEF) from 64.00 ± 18.21% to 75.09 ± 12.98% (p = 0.001). Three patients improved their LVEF from 31 to 55%, 31 to 67%, and 26 to 50%. The median length of stay was 8 (2-35) days, with an ICU stay of 2 (0-30) days. The median time from RVOT stent palliation to total repair was 3 months (range: 1 month-12 months). RVOT stenting is a safe and effective method for increasing saturation and ejection fraction not only in newborn infants but also in late presenters, including adults with unrepaired Fallot physiology.

Esophageal stent dysfunction: unclogging the Red Sea.

Self-expandable metal stents (SEMS) have been widely used for the palliation of esophageal malignant dysphagia. Stent-related dysphagia is frequent and should raise the suspicion of stent migration, tumor ingrowth or overgrowth. In addition, bleeding has been reported in nearly 7% of patients. Nonetheless, this is the first case report of a complete stent obstruction by abundant blood clot formation. The authors present a 76-year-old male with severe ischemic heart disease and atrial fibrillation, requiring cardiac resynchronization therapy defibrillator and anticoagulation. After being diagnosed with metastasized squamous cell mid-esophageal cancer, he was proposed for chemotherapy and palliative esophageal stenting.

Palliative stenting of malignant strictures causing afferent loop syndrome via the percutaneous transhepatic biliary drainage in patients with endoscopically inaccessible lesions

Palliative stenting of malignant strictures causing afferent loop syndrome via the percutaneous transhepatic biliary drainage in patients with endoscopically inaccessible lesions

Broncho-esophageal fistula: When surgery and endoscopy fail, consider physiological lung exclusion

We discuss the case of an esophageal cancer patient treated by chemo and radiotherapy complicated by an esophageal stenosis and an iatrogenic broncho-esophageal fistula. This latter was managed with multiple palliative stenting procedures and colonic surgical bypass. Despite a long disease free survival but decreased quality of life and frailty, we came to the proposal of an extremely unusual form of treatment - physiological lung exclusion, with clinical benefit and so far without any drawbacks related to the procedure.

OGC P53 Recurrent oesophageal cancer involving complex gastro-pleural fistula: a rare case report on the role of palliative endoscopic stenting

Abstract Background Oesophageal cancer ranks as the 14th most common cancer in the United Kingdom and has witnessed improved survival rates due to advancements in treatment. However, despite initial treatment with curative intent, there is a risk of recurrence associated with poor prognosis. Recurrent oesophageal cancer is typically detected at an advanced stage with predominantly palliative treatment options. In rare cases, a cancer-related fistula can develop between the respiratory system and the oesophagus. This complication poses a risk of sepsis with diminished quality of life; therefore, prompt management of such fistulas with consideration of palliative endoscopic stenting is essential. Methods We present a case of a patient with a gastro-pleural fistula due to recurrent oesophageal cancer following initial treatment in 2016. She received neoadjuvant chemoradiotherapy which down-staged the tumour from pT3 to ypT2, followed by Ivor-Lewis oesophagectomy for a mid-oesophageal squamous cell carcinoma with complete resection margin. Metastatic disease was detected in the right superior mediastinal node in 2018, which was treated by radical chemoradiotherapy. In 2022, further recurrence was detected in a fistulating mass involving the gastric conduit, right posterior chest, pleura and overlying soft tissue. The multidisciplinary team recommended palliative chemotherapy and endoscopic stenting of the fistula. Results Endoscopic stenting is a palliative adjunct in advanced oesophageal cancer to alleviate dysphagia and allow oral nutrition. In this patient, we describe a novel approach of double stenting using the Ovesco Stenfix system, performed by an oesophago-gastric surgeon. Two stents were deployed in a ‘piggyback’ technique to completely occlude the fistula site and secured using Ovesco clips, hence maintaining a single conduit to pass food and fluid through the gastrointestinal tract. Stent placement was confirmed to be satisfactory with fluoroscopy. The patient was admitted 48 hours post-procedure and discharged without intra-procedural complications once oral intake was resumed. Conclusions Despite advances in the treatment of potentially curable oesophageal cancer, recurrence of the disease still occurs with devastating sequelae. As observed in our patient, recurrence in the form of complex fistulating mass is infrequent and associated with significant morbidity. Endoscopic palliative stenting was a safe option with good technical success.

Fully versus partially-covered self-expandable metal stents for palliation of distal malignant biliary obstruction: a meta-analysis.

Fully versus partially-covered self-expandable metal stents for palliation of distal malignant biliary obstruction: a meta-analysis.

Palliative interatrial septum stenting with a vascular stent in a chronic thromboembolic pulmonary hypertension patient: Is it beneficial?

BackgroundChronic thromboembolic pulmonary hypertension (CTEPH) is a serious disease that can progress and lead to a deadly outcome. Despite optimal drug therapy, pulmonary hypertension (PH) remains fatal. Untreatable right heart failure (RHF) from CTEPH is eventually a significant cause of death. However, unloading the right heart and increasing systemic output are the treatment goals in these patients.Case presentationA 42-year-old female presented to the emergency department with worsening dyspnea experienced for three days before admission. There were also complaints of leg edema, ascites, orthopnea, and palpitation. Physical examination revealed an attenuated second heart sound, abdominal ascites, and bilateral leg edema. She had a history of frequent readmissions due to RHF despite optimal medical therapy and was diagnosed with CTEPH 5 months ago. It was decided that the patient would undergo interatrial septal (IAS) stenting with a vascular stent of 8 mm × 39 mm × 135 cm. The results were good; her symptoms and signs of RHF improved, and she was eventually discharged from the hospital. Four months after the procedure, the patient was able to engage in physical activities without any limitations.ConclusionsA palliative IAS stent is one of the choices for intractable RHF management in patients with CTEPH. The vascular stent can be used as an alternative in order to make the interatrial connection more stable and last longer.

A Japanese Prospective, Multicenter Study of Colonic Stenting for Palliation Using a High Axial Force Self-Expandable Metal Stent for Malignant Large Bowel Obstruction in 200 Patients.

Evidence of the efficacy and safety of colorectal stent placement for palliation remains insufficient. This single-arm, prospective, multicenter study with a WallFlex enteral colonic stent included 200 consecutive patients with malignant large bowl obstruction in the palliation cohort. The technical and clinical success, as well as stent patency and complications as short-term (≤7 days) and long-term (>7 days) outcomes, of high axial force self-expandable metal stent (SEMS) placement was evaluated. The technical and clinical success rates were 98.5% and 94.5%, respectively. Non-recurrent colorectal obstruction at 1 year was 63.9%, and 71.2% of the patients remained free of recurrent colorectal obstruction until death or the last follow-up. Fifty-six patients (28.0%) received chemotherapy, and five patients were administered bevacizumab after stent placement. The overall complication rate was 47%, including four (2.0%) early-onset and ten (5.0%) late-onset perforations, mostly due to stent-edge injury. Only the use of a long SEMS was a risk factor for perforation. In conclusion, endoscopic colorectal stenting using high axial force SEMS is an effective and safe procedure for palliation in patients with malignant colorectal obstruction. However, care should be taken to avoid perforation at the stent edge when using a long SEMS.