Safety Of Self-expandable Metal Stents Research Articles

Esophageal Stent in Acute Refractory Variceal Bleeding: A Systematic Review and a Meta-Analysis.

Background: Acute esophageal variceal bleeding accounts for up to 70% of upper-gastrointestinal bleeding in cirrhotic patients. About 10-20% of patients with acute variceal bleeding have refractory bleeding that is not controlled by medical or endoscopic therapy, and this condition can be life-threatening. Balloon tamponade is a long-standing therapy which is only effective temporarily and has several complications, while transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation may not be readily available at some centers. The use of self-expandable metal stents (SEMSs) in refractory esophageal variceal bleeding has been studied for effectiveness and adverse events and has been recommended for use as a bridge to a more definitive treatment. Aim: To investigate the effectiveness and safety of SEMSs in managing refractory variceal bleeding. Methods: A systematic search of the MEDLINE, EMBASE, and Cochrane library databases was performed from inception to October 2022 using the following terms: "esophageal stent", "self-expandable metal stents", "endoscopic hemostasis", "refractory esophageal varices", and "esophageal variceal bleeding". Studies were included in the meta-analysis if they met the following criteria: (1) patients' age older than 18 and (2) a study (or case series) that has at least 10 patients in the study. Exclusion criteria included (1) non-English publications, (2) in case of overlapping cohorts, data from the most recent and/or most appropriate comprehensive report were collected. DerSimonian-Laird random-effects meta-analysis was performed using the meta package in R statistical software(version 4.2.2). Results: Twelve studies involving 225 patients with 228 stents were included in the analyses. The mean age and/or median age ranged from 49.4 to 69 years, with a male-to-female ratio of 4.4 to 1. The median follow-up period was 42 days. The mean SEMS dwell time was 9.4 days. The most common cause of acute refractory variceal bleeding in chronic liver disease patients included alcohol use followed by viral hepatitis. The pooled rate of immediate bleeding control was 91% (95% CI 82-95%, I2 = 0). The pooled rate of rebleeding was 17% (95% CI 8-32%, I2 = 69). The pooled rate of stent ulceration was 7% (95% CI 3-13%, I2 = 0), and the pooled rate of stent migration was 18% (95% CI 9-32%, I2 = 38). The pooled rate of all-cause mortality was 38% (95% CI 30-47%, I2 = 34). Conclusions: SEMSs should be primarily considered as salvage therapy when endoscopic band ligation and sclerotherapy fail and can be used as a bridge to emergent TIPS or definitive therapy, such as liver transplantation.

Impact of radiotherapy on adverse events of self-expanding metallic stents in patients with esophageal cancer.

Self-expanding metallic stents (SEMS) are considered the treatment of choice for the palliation of dysphagia and fistulas in inoperable esophageal neoplasms. However, the safety of SEMSs in patients who received or who will be submitted to radiotherapy (RT) is uncertain. The study aimed to evaluate the impact of RT on adverse events (AEs) in patients with esophageal cancer with SEMSs. This is a retrospective study conducted at a tertiary cancer hospital from 2009 to 2018. We collected information regarding RT, the histological type of the tumor, the model of SEMSs and AEs after stent placement. Three hundred twenty-three patients with malignant stenosis or fistula were treated with SEMSs. The predominant histological type was squamous cell carcinoma (79.6%). A total of 282 partially covered and 41 fully covered SEMSs were inserted. Of the 323 patients, 182 did not received RT, 118 received RT before SEMS placement and 23 after. Comparing the group that received RT before stent insertion with the group that did not, the first one presented a higher frequency of severe pain (9/118 7.6% vs. 3/182 1.6%; P = 0.02). The group treated with RT after stent placement had a higher risk of global AEs (13/23 56.5% vs. 63/182 34.6%; P = 0.019), ingrowth/overgrowth (6/23 26.1% vs. 21/182 11.5%; P = 0.045) and gastroesophageal reflux (2/23 8.7% vs. 2/182 1.1%; P = 0.034). Treatment with RT before stent placement in patients with inoperable esophageal neoplasm prolongs survival and is associated with an increased risk of severe chest pain. Treatment with RT of patients with an esophageal stent increases the frequency of minor, not life-threatening AEs.

EUS-guided choledochoduodenostomy for malignant biliary obstruction: A multicenter comparative study between plastic and metallic stents.

EUS-guided choledochoduodenostomy (EUS-CDS) is commonly employed to address malignant biliary obstruction (MBO) after a failed ERCP. In this context, both self-expandable metallic stents (SEMSs) and double-pigtail stents (DPSs) are suitable devices. However, few data comparing the outcomes of SEMS and DPS exist. Therefore, we aimed to compare the efficacy and safety of SEMS and DPS at performing EUS-CDS. We conducted a multicenter retrospective cohort study between March 2014 and March 2019. Patients diagnosed with MBO were considered eligible after at least one failed ERCP attempt. Clinical success was defined as a drop of direct bilirubin levels ≥ 50% at 7 and 30 postprocedural days. Adverse events (AEs) were categorized as early (≤7 days) or late (>7 days). The severity of AEs was graded as mild, moderate, or severe. Forty patients were included, 24 in the SEMS group and 16 in the DPS group. Demographic data were similar between the groups. Technical success rates and clinical success rates at 7 and 30 days were similar between the groups. Similarly, we found no statistical difference in the incidence of early or late AEs. However, there were two severe AEs (intracavitary migration) in the DPS group and none in the SEMS cohort. Finally, there was no difference in median survival (DPS 117 days vs. SEMS 217 days; P = 0.99). EUS-guided CDS is an excellent alternative to achieve biliary drainage after a failed ERCP for MBO. There is no significant difference regarding the effectiveness and safety of SEMS and DPS in this context.

Efficacy and safety of self-expanding metal stents in patients with inoperable esophageal cancer: a real-life study.

Dysphagia is the most frequent symptom in patients diagnosed with esophageal cancer. Self-expanding metal stents (SEMS) are the current palliative treatment of choice for dysphagia in patients with non-curable esophageal cancer. This study aimed to evaluate the efficacy and adverse events (AEs) of different types of SEMS for palliation of dysphagia. We performed a retrospective cohort study of patients with advanced esophageal cancer and SEMS placement for dysphagia palliation in a tertiary care center. The primary outcome was the clinical success defined as an improvement in dysphagia (reduction of at least 2 points in the Mellow-Pinkas scoring system for dysphagia) after SEMS placement. Between January 1999 and May 2020, 295 patients with esophageal cancer were identified. Among them, 75 had a SEMS placement for dysphagia palliation. The mean age of the patients was 61.3 years (standard deviation: 13.4), 69 patients (92%) were men, and the mean Mellow-Pinkas scoring for dysphagia pre- and post-SEMS placement were 3.1 and 1.4 (change from baseline -1.7), respectively. Technical success and clinical success were achieved in 98.6% and 58.9%, respectively. AEs were identified in 35/75 patients (46.7%), and SEMS migration was the most frequent AE in 22/75 patients (29.3%). There were no significant differences in improvement in dysphagia (p = 0.054), weight changes (p = 0.78), and AE (p = 0.73) among fully covered SEMS (fc-SEMS) and partially covered SEMS (pc-SEMS). The median follow-up was 89 days (interquartile range: 29-221). SEMS placement was associated with a rapid improvement in dysphagia, high technical success, and a modest improvement in dysphagia with no major AE among fc-SEMS and pc-SEMS.

Palliative stenting for malignant colorectal stenosis in the elderly.

ObjectivesSelf‐expandable metal stents are widely used for the treatment of malignant colorectal stenosis (MCS). In elderly individuals with MCS, self‐expandable metal stents are often used as a palliative treatment, but prophylactic stent placement is not recommended. We investigated the efficacy and safety of self‐expandable metal stents for the elderly in a palliative setting, specifically in a prophylactic setting.MethodsElderly patients with MCS who received a palliative stent (the stent group) or palliative stoma (the stoma group) were retrospectively enrolled between April 2017 and June 2022, and the prognosis and complication rates were assessed. Additionally, patients in the stent group were divided into symptomatic and asymptomatic subgroups, and prognosis, stent patency, and complication rates were evaluated.ResultsDuring the study period, 31 patients with a mean age of 85.4 years and 12 patients with a mean age of 82.0 years were enrolled in the stent and stoma groups, respectively. While overall survival and complication rates were comparable, the length of hospital stay was significantly shorter in the stent group. Of the 31 patients in the stent group, 16 asymptomatic patients received prophylactic stenting, which was not associated with increased complication rates.ConclusionsPalliative stents for MCS appear to be effective and safe even in the elderly, and thus, prophylactic stents can be considered for asymptomatic patients.

Self-Expanding Metal Stents for Anastomotic Leaks After Upper Gastrointestinal Cancer Surgery

BackgroundAnastomotic leakage (AL) is a common and severe complication after upper gastrointestinal (UGI) surgery. Although evidence is scarce, endoscopic deployed self-expanding metal stents (SEMS) are well-established for the management of AL in UGI surgery. The present study aimed to evaluate the feasibility, effectiveness, and safety of SEMS in terms of success, mortality, and morbidity in patients with AL after UGI cancer surgery. Materials and MethodsPatients with AL after primary UGI cancer surgery were retrospectively analyzed with regard to demographics, disease, surgical and endoscopic procedures, and complications. Stent treatment success was divided into technical, primary (within 72 hours of stent deployment), sustained (after 72 hours of stent deployment), and sealing success. ResultsIn a total of 63 patients, 74 stents were used and 11 were deployed in endoscopic reinterventions. Stent deployment was successful in all patients. Primary and sustained success rates were 68.3% (n = 43) and 65.1% (n = 41), respectively. Of the primarily successfully treated patients, 87.8% remained successfully treated. If primary treatment was unsuccessful, it remained unsuccessful in 66.6% of the patients (P = 0.002). Final sealing of the leakage was observed in 65.1% of patients (n = 41). Longer stent shafts and wider stent end widths were correlated with successful stent treatment (P < 0.05). ConclusionSEMS are a safe and sufficient tool in the treatment of AL after UGI cancer surgery. Treatment success is improved with longer stent shafts and wider stent end widths. Switching to alternative treatments is strongly suggested if signs of persistent leakage are present beyond 72 hours after stent placement, as this is highly indicative of sustained stent failure.

P-249 Long-term oncologic safety of self-expandable metal stent as a bridge to surgery for obstructing colon cancer

About 10-25% patients of with colorectal cancer suffer from acute colonic obstruction. Recently, placement of a self-expanding metal stent (SEMS) was widely used and it seems to be a safe and effective “bridge to surgery”, offering good palliation. But there is concern about long-term survival after the use of SEMS. Theoretically, tumor cell seeding can occur due to mechanical force during the stent insertion. To identify this theoretical validity, we surveyed long-term survival of malignant colonic obstruction using SEMS placement.

Usefulness of self-expandable metal stents for malignant biliary obstruction using a short-type single-balloon enteroscope in patients with surgically altered anatomy.

To evaluate the efficacy and safety of self-expandable metal stent (SEMS) placement for unresectable malignant biliary obstruction (MBO) using a short-type single-balloon enteroscopy (short SBE) in patients with surgically altered anatomy (SAA). The technical success rate, clinical success rate, recurrent biliary obstruction (RBO), time to RBO (TRBO), procedure related adverse events, and reintervention after RBO were evaluated from September 2011 to June 2020. Thirty-seven patients (11 patients with distal MBO and 26 with hilar MBO) who underwent SEMS placement were included in the analysis. The technical and clinical success rates were 100% and 94.6%. Seven patients underwent bilateral stenting (partial stent-in-stent placement) for hilar MBO. The RBO rate was 13.5% (5/37) and the median TRBO was 212 (interquartile range [IQR], 154-296) days. No food impaction occurred in this study. Procedure related adverse events occurred in 5.4% (2/37) of cases. Reintervention was attempted in five patients and all succeeded (four patients underwent SEMS replacement, and one underwent plastic stent placement). SEMS placement for unresectable MBO using a short SBE in patients with SAA is effective and safe in similar ways to that in patients with normal anatomy in terms of bilateral stenting, stent patency, and reintervention.

Endoscopic vacuum therapy versus endoscopic stenting for upper gastrointestinal transmural defects: Systematic review and meta-analysis.

Upper gastrointestinal fistulas, leaks, and perforations represent a high cost burden to health systems worldwide, with high morbidity and mortality rates for affected patients. Management of these transmural defects remains therapeutically challenging. The aim of this study is to perform a systematic review and meta-analysis to investigate the efficacy and safety of self-expanding metal stents (SEMS) versus endoscopic vacuum therapy (EVT) for treatment of upper gastrointestinal transmural defects. Searches were performed on MEDLINE, EMBASE, Central Cochrane, Latin American and Caribbean Health (LILACS), and gray literature, as well as a manual search to identify studies comparing SEMS versus EVT to treat upper gastrointestinal transmural defects. Evaluated outcomes were: rates of successful closure, mortality, length of hospital stay, duration of treatment, and adverse events. Five studies with a total of 274 patients were included. There was a 21% increase in successful fistula closure attributed to EVT compared with the SEMS group (RD 0.21, CI 0.10-0.32; P=0.0003). EVT demonstrated a 12% reduction in mortality compared to stenting (RD 0.12, CI 0.03-0.21; P=0.006) and an average reduction of 14.22days in duration of treatment (CI 8.38-20.07; P<0.00001). There was a 24% reduction in adverse events (RD 0.24, CI 0.13-0.35; P=0.0001. There were no statistical differences between the studied therapies regarding the length of hospital stay. Endoscopic vacuum therapy proves to be superior in successful defect closure, mortality, adverse events and duration of treatment.

Feasibility and safety of self-expandable metal stent in nonmalignant disease of the lower gastrointestinal tract.

In recent years, self-expandable metal stents (SEMSs) have been employed to treat benign gastrointestinal strictures secondary to several conditions: Acute diverticulitis, radiation colitis, inflammatory bowel disease (IBD), and postanastomotic leakages and stenosis. Other applications include endometriosis and fistulas of the lower gastrointestinal tract. Although it may be technically feasible to proceed to stenting in the aforementioned benign diseases of the lower gastrointestinal tract, the outcome has been reported to be poor. In fact, in some settings (such as complicated diverticulitis and postsurgical anastomotic strictures), stenting seems to have a limited evidence-based benefit as a bridge to surgery, while in other settings (such as endometriosis, IBD, radiation colitis, etc.), even society guidelines are not able to guide the endoscopist through decisional algorithms for SEMS placement. The aim of this narrative paper is to review the scientific evidence regarding the use of SEMSs in nonmalignant diseases of the lower gastrointestinal tract, both in adult and pediatric settings.

Determining the difference in the efficacy and safety of self-expandable metallic stents as a bridge to surgery for obstructive colon cancer among patients in the CROSS 0 group and those in the CROSS 1 or 2 group: a pooled analysis of data from two Japanese prospective multicenter trials

PurposeThis study compared the feasibility and safety of endoscopic placement of self-expandable metallic stents (SEMSs) as a bridge to surgery (BTS) between patients with obstructive colorectal cancer (CRC) classified as ColoRectal Obstruction Scoring System (CROSS) 0 and those with CROSS 1 or 2.MethodsWe conducted a post hoc analysis of two prospective, observational, single-arm multicenter clinical trials and performed a pooled analysis of the data. In total, 336 consecutive patients with malignant colorectal obstruction underwent SEMS placement. The primary endpoint was clinical success, defined as resolution of symptoms and radiological findings within 24 h. Secondary endpoints were technical success and adverse events.ResultsHigh clinical (98.0% vs. 98.4%) and technical (96.7% vs. 97.8%) success rates were observed in both groups (CROSS 0 vs. CROSS 1 or 2). The adverse event rate was low. The mean stricture length was lower (3.8 ± 1.2 cm vs. 4.4 ± 1.8 cm) and laparoscopic surgery more common (56.7% vs 52.2%) in the CROSS 0 group than in the CROSS 1 and 2 group.ConclusionThis study was the first to compare the degree of stricture in different CROSS groups and demonstrated comparable results with respect to the short-term efficacy and safety of SEMS placement as a BTS for obstructive CRC in CROSS 0, 1, and 2 patients.

Long-term oncologic safety of self-expandable metal stent as a bridge to surgery for malignant colorectal obstruction: Our experience.

153 Background: About 10-25% patients of colorectal cancer suffer from acute colonic obstruction. Traditional management of acute malignant bowel obstruction has focused on emergency resection but showed high mortality and morbidity rates. Recently, placement of a self-expanding metal stent(SEMS) was widely used and SEMS seems to be as a safe and effective “bridge to surgery” and to offer good palliation. But there is concern about long-term survival after the use of SEMS. Theoretically, tumor cell seeding can occur due to mechanical force during the stent insertion. To identify this theoretical validity, we surveyed long-term survival of malignant colonic obstruction using SEMS placement. Methods: This retrospective study included 303 patients who presented in Korea University Anam Hospital between 2006 and 2014 with obstructing CRC, and underwent surgical resection. Patients were devided into two group: the “SEMS” group included 148 patients who underwent endoscopic stent as a bridge to surgery, and the surgery group included 155 patients who underwent emergency or elective surgery without stenting. In addition, candidates for curative resection were identified (98 patients in “SEMS” group vs 101 patients in “surgery” group). The clinicopathologic characteristics, overall survival(OS), and recurrence-free survival (RFS) were compared between the two groups. Results: There was no significant difference in demographics, tumor stage between the two group. The median follow-up times were 48.5 months (IQR, 19.1-73.1 months) for the SEMS group and 39.4 months (IQR, 15.1-39.4 months) for the surgery group. There was no significant difference in 5-year OS rate between two groups (59.6% vs 56.8%; p = 0.3). The 5-year RFS rate did not significantly differ between two groups (71.0% vs. 61.3%; p = 0.221). The long-term oncologic safety did not significantly differ between two groups in either the 5-year OS rate (79.5% vs 74.5%; P= 0.6). or the 5-year RFS rate (95.8% vs 95.8%; P = 0.3). Conclusions: SEMS as bridge to surgery in obstructive CRC did not worsen the long-term oncologic outcomes compared to those of the primary surgery.

Self-Expanding Metal Stents for the Treatment of Post-Surgical Esophageal Leaks: A Tertiary Referral Center Experience

Background/Aims: The study aimed to evaluate the effectiveness and safety of self-expanding metal stents (SEMS) in the management of post-surgical esophageal leaks. Methods: Retrospective data of consecutive patients with a post-surgical esophageal leak treated by means of a metal stent between January 2008 and December 2014 at the Humanitas Research Hospital (Milan, Italy) were extracted from a prospectively maintained register of SEMS used for benign indications, such as post-surgical benign esophageal strictures and/or leaks. The primary outcome of the study was to assess the rate of successful leak closure and to identify the variables associated with its achievement. As a secondary outcome, we evaluated the overall safety of SEMS placement and the efficacy and safety for different types of SEMS in this specific setting of patients. Leak resolution was documented with endoscopic and/or imaging studies. In the case of leak persistence, further attempts of esophageal stenting were carried out at the discretion of both endoscopists and surgeons. Results: A total of 49 patients were included in the study (men 41 of 49, 83.7%, mean age 62.4 ± 11.9). One patient was excluded from analysis, because of death 1 day after stent insertion due to worsening of pre-existing mediastinitis. A total number of 82 stents were placed (mean number of stents per patient: 1.7) in 49 patients: 35 patients (71.4%) received a partially covered SEMS (PCSEMS) as the first stent positioned, while the remaining 14 (28.6%) received a fully covered SEMS (FCSEMS); but 1 patient (2%) died following stent insertion; therefore, data regarding therapeutic success were available for 48 patients. Stents were left in place for a mean period of 21.9 ± 15.2 days. Leak closure after the first stent placement was achieved in 22 of 48 (45.8%) patients. Of the 26 patients with failure of index stent placement, 18 patients underwent further stenting attempts (69.2%), and secondary closure of leak was achieved in 7 (38.9%) of these 18 patients. Thus, the overall success rate was 60.5% (29 of 48). On the basis of stent type, the success rate was 57.1% (8 of 14) for FCSEMS and 64.7% (22 of 34) for PCSEMS. Logistic regression analysis did not find any significant association between successful leak closure and analyzed variables. Overall mortality was 13.0%. Complication rate was 38.8% (19 of 49 patients). Conclusion: The use of SEMS is an effective and safe option for post-surgical esophageal leaks, with no evidence of any significant influence of stent type on outcome.

PD-016 - Safety of self-expandable metal stents (SEMS) or emergency surgery for acute colonic obstruction in metastatic colon cancer patients treated with bevacizumab

Introduction: Colorectal cancer presents with malignant bowel obstruction in about 10% of cases. SEMS can be an alternative for immediate surgery although long-term data is limited regarding clinical outcomes and safety of Bevacizumab (BV) in this subset of patients. The aim of this study was to evaluate procedure-related morbidity in relation to the type of previous or subsequent medical treatment used, including BV. Methods: We performed a retrospective review of 2850 cases of metastatic colon cancer diagnosed from January 2012 to October 2017, and identified those patients with malignant bowel obstruction that were initially treated with either SEMS or emergency surgery. Differences in procedure-related morbidity were assessed by the Chi-square test, overall survival (OS) with the log-rank test and a multivariate analysis with Cox proportional-hazards model was performed. Results: We selected 119 cases, 79 of which were treated with SEMS and 40 with surgery. Median age was 76. Median follow-up time was 11 months. No differences in sidedness or RAS status between cohorts. SEMS had a similar rate of complications compared to surgery (32.5% vs 35.5%, p = 0.45) and showed longer time to complications (18m vs 1m, p = 0.004). In patients treated with BV, complications were similar in SEMS and surgery groups (40% vs 31%, RR 1.28, p = 0.45), the incidence of perforation was similar in patients with SEMS compared to surgery (16% vs 7%, RR 1.09, p = 0.16) and when BV regimen is compared to chemotherapy alone (16% vs 6%, RR 1.11, p = 0.16). SEMS and surgery showed similar OS (14m vs 15m, p = 0.5). Treatment with BV increased OS in both the SEMS group (18 months vs 7 months, p = 0.001) and the surgery group (20 months vs 4 months, p = 0.001) compared to patients without subsequent medical treatment. Also, BV treatment showed a trend for longer OS when compared to chemotherapy alone in the SEMS group (18 months versus 15 months, p = 0.13) and in the surgery group (20 months versus 17 months, p = 0.13). In the multivariate analysis, patients treated with subsequent medical treatment showed a statistically significant longer OS [Hazard Ratio (HR) 0.43, Confidence Interval (CI) 95% 0.19-0.94, p = 0.02], patients with left-sided colon cancer showed a trend for longer OS (HR 0.5, CI95% 0.22-1.13, p = 0.09) and, in those patients who had complications, we observed shorter OS (HR 2.45, CI95% 1.17-5.12, p = 0.01). Conclusion: SEMS was associated with a similar outcome than emergency surgery and, furthermore, using BV was not associated with a higher risk of complication. In patients with metastatic colorectal cancer with acute malignant colon obstruction, SEMS is a safe option, including patients that received BV.

Safety of self-expandable metal stents (SEMS) or emergency surgery for acute malignant colonic obstruction in patients treated with bevacizumab.

e15505Background: Colorectal cancer presents with malignant bowel obstruction in about 10% of cases. SEMS can be an alternative for immediate surgery although long-term data is limited regarding cl...

Use of Self-Expandable Metal Stents in the Treatment of Leaks Complicating Laparoscopic Sleeve Gastrectomy: A Cohort Study.

Use of a self-expandable metal stent (SEMS) as an initial intervention for leaks after laparoscopic sleeve gastrectomy (LSG) has increased. We assessed the efficacy and safety of SEMS in the treatment of post-LSG leaks, and the determinants of repeated rounds of stenting. A retrospective chart review was conducted at a university hospital in Saudi Arabia. The study included patients who developed leaks after undergoing LSG between October 2011 and April 2016. Sixty-four patients (mean age, 35.69 ± 10.71years) were included; 55% were males. The mean estimated size of the defect was 1.18cm; partially covered SEMS and fully covered SEMS were used as the initial stents in 82.81 and 17.19% patients, respectively. One round of stenting was required in most patients (82.81%), two rounds in 10.94%, and three rounds in 6.25%. Clinical success was achieved in 93.75% patients, including 78.13% in the first round, 89.06% by the second round, and 93.75% by the third round. A higher proportion of patients who needed one round of stenting received a partially covered SEMS compared to those who needed two rounds (91.11 vs. 42.86%, p < 0.01). Additionally, the rate of migration in patients who underwent two rounds was higher than that in patients who underwent one round (42.86 vs. 5.26%, p < 0.01) of stenting. Repeated stenting for leaks after LSG is an effective and safe intervention. The efficacy of partially covered SEMS appears superior to that of the fully covered SEMS.

Endoscopic treatment of anastomotic biliary stricture after adult deceased donor liver transplantation with multiple plastic stents versus self-expandable metal stents: a systematic review and meta-analysis.

Anastomotic biliary strictures (ABSs) occur in up to 15% of patients after liver transplantation (LT). The aim of this study was to compare the efficacy and safety of self-expandable metal stents (SEMS) versus multiple plastic stents (MPS). Databases were searched through April 2017. The outcome measures were technical success, stricture resolution, recurrence and complications. We synthesized the findings descriptively and performed a meta-analysis. Three randomized controlled trials and one retrospective cohort study were identified, including 179 MPS and 119 SEMS patients. Outcome data were pooled in a meta-analysis that showed an advantage of SEMS in terms of the number of ERCP procedures (mean difference: 1.69 ERCP; 95% CI, 1-2.39; P < 0.00001) and treatment days (mean difference: 40.2 days; 95% CI, 3.9-76.4; P = 0.03), with no differences in terms of ABS resolution or recurrence. Fourteen case series reported MPS outcomes and fifteen reported SEMS outcomes, including 647 and 419 patients, respectively. Based on low-quality evidence, we cannot draw any reliable conclusions on the superiority of MPS or SEMS strategies. Even though shorter treatment times and fewer ERCP procedures support the use of SEMS, whether one technique has well-defined advantages over the other remains unclear.

P.08.14: Efficacy and Safety of Self-Expanding Metal Stents for Colon Cancer: An Analysis of 10 Years’ Experience of a Third Referral Center

P.08.14: Efficacy and Safety of Self-Expanding Metal Stents for Colon Cancer: An Analysis of 10 Years’ Experience of a Third Referral Center

Oncologic safety of self-expanded metal stent insertion as a bridge to elective surgery in malignant colorectal obstruction

Purpose Colorectal obstruction develops most frequently by carcinoma, and 7%–30% of these colorectal carcinomas are acute cases. The oncologic safety of self-expanding metal stent (SEMS) insertion as a bridge to surgery has not yet been established. Thus, we investigated the oncologic safety of SEMS insertion as a bridge to surgery in patients with obstructive colorectal cancer. Methods This retrospective had 56 patients enrolled requiring emergency management for obstructive colorectal cancer at stage II or III, who had undergone curative surgery between July 2008 and June 2011. These subjects were divided into two groups: patients who had undergone emergency surgery without SEMS insertion (non-stent group) and those who had undergone elective surgery after preoperative decompression with SEMS insertion (stent group). The two groups were compared for clinicopathologic characteristics, postoperative complications, and survival rate. Results Enterostomy was performed in 25 patients (100.0%) in the non-stent group and 1 patient (3.2%) in the stent group; laparoscopic surgery was carried out in 7 patients (28.0%) in the non-stent group and 19 patients (61.29%) in the stent group, each showing statistically significant differences. There was no statistically significant difference in postoperative complications and 5-year disease-free survival rate (72% vs. 74.19%, P=0.87, respectively). Conclusion In treatment of malignant colorectal obstruction, elective operation after stent insertion had similar oncologic outcomes compared with emergency operation. Preoperative stent insertion not only lowers the incidence of enterostomy but also makes laparoscopic surgery possible, thereby enhancing patients’ quality of life. Therefore, preoperative stent insertion is a useful method that may replace emergency surgery in treatment of malignant colorectal obstruction. Keywords: Self-expanding metal stent, Colorectal cancer, Intestinal obstruction, Oncologic outcome

PTH-017 Safety of self-expandable metal stents for malignant biliary strictures in a district general hospital setting

Introduction Self-expandable metal stent (SEMS) are widely used as first line palliative therapy for unresectable malignant biliary strictures. We present our experience of use of self-expandable metal stents in malignant biliary strictures in a District General Hospital (DGH) setting. Method We conducted a retrospective review on the data of all patients who had undergone an ERCP with a placement of self-expandable metal stent for inoperable malignant biliary strictures between Jan 2009 and Aug 2014. Comprehensive information was gathered with regards to patient’s demographics, procedural indications and procedure success rates. We assessed the stents efficacy, stent patency rates, complications and patient survival rates Results 50 patients were identified and analysed during this period. 60% were females and the mean age was 72 years (range, 35–93 years). The most common underlying diagnoses were Pancreatic carcinoma (60%) and Cholangiocarcinoma (32%) followed by Ampullary Carcinoma (6%) and Lymphoma (2%). Indications for metal stent placement included malignant bile duct stricture (54%), blockage of old stents (42%) and stent migration (4%). 23/50 (42%) patients had previous stent placement (Plastic 18, Metal 5). Of these, 21 stents failed due to blockage either due to biliary sludge or tumour overgrowth while 2 stents had migrated out (both plastic stents). The mean duration of previous stent patency was; plastic 96 days (7–523 days) and metal 237 days (39–595 days). The types of metal stents used were; Fully Covered (28%), Partially Covered (32%) and Uncovered (40%). The mean duration of all metal stents patency was 122 days (range, 7 – 566 days) and there was no statistical difference in terms of duration of stent patency among fully covered, partially covered and uncovered stents. Overall complication rate was 18%, which included Cholangitis (2%) and Stent Blockage (8/50, 16%) mainly due to biliary sludge (6/8). Of these blocked stents 5 were Fully covered, 3 Partial covered, 1 was Uncovered. There were no cases of post ERCP pancreatitis or migration of metal stent. There were no reported cases of procedure related mortality. The mean survival period after metal stent insertion was 161 days (range 9 to 566). Conclusion Self-expandable metal stents offers safe and effective palliative therapy for inoperable malignant biliary strictures and can be safely performed in a district general hospital with low complication rates. High blockage rate of fully covered stents is in our series is unexpected and the reasons for this were not obvious but this would be the subject of further analysis and study. Disclosure of interest None Declared.