Self-expanding Metal Stents For Palliation Research Articles

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.).

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.

Self-Expanding Metallic Stents for Palliation of Esophageal Cancer: A Single Center Experience From Saudi Arabia.

Self-expanding metallic stents (SEMSs) are increasingly used as a non-surgical alternative for the palliation of advanced esophageal cancer (EC). However, there is a scarcity of real-life experience with the use of these stents exclusively in EC. The aim of this study is to evaluate the efficacy of SEMS in inoperable ECs in the western region of Saudi Arabia. A retrospective review of SEMS placed in a tertiary referral hospital for histologically proven inoperable EC from 2016 to 2019. Demographics data, procedure success, complication, re-intervention, and mortality were analyzed. Forty-eight SEMS placed in 35 patients for palliation of dysphagia. The median age of patients was 68 years (range 31-95). 69% (24) patients have a lower third of EC and the rest have a middle third. SEMSs were placed successfully in all cases with symptomatic improvement. No major stent-related complication was seen. 28% (13) patients required re-intervention with additional SEMS placement, nine of which were for tissue in growth and four for distal migration. Median survival was 114 days (range 30-498). Most of the complications seen in fully covered SEMS compared to the partially covered 50% (8/16) vs 17% (5/30), respectively, p = 0.04. Chemo and/or radiotherapy were given to 51% (18) of the patients without any significant benefit on survival (p = 0.79) or re-intervention rate (p = 0.47) compared to those who did not. SEMSis effective in palliating dysphagia in inoperable EC without major complications. Rates of tumors in growth and migration were comparable to other studies. SEMS provides long-term palliation.

Covered versus uncovered double bare self-expandable metal stent for palliation of unresectable extrahepatic malignant biliary obstruction: a randomized controlled multicenter trial

In a recent randomized controlled trial, a double bare metal stent (DBS) showed better stent patency than single-layer metal stents. However, clear evidence comparing the efficacy of uncovered (UCDBS) and partially covered (PCDBS) DBSs for distal malignant biliary obstruction (MBO) is lacking. Therefore, we compared the clinical outcomes including stent patency of UCDBSs versus PCDBSs. A multicenter, randomized study was performed in patients with distal MBO. The primary endpoint was stent patency. Secondary endpoints were the proportion of patients with patent stents at 6 months, risk factors for stent dysfunction, overall survival, technical and clinical success rates of stent placement, and other adverse events (AEs). Among 258 included patients, 130 were randomly assigned to the PCDBS group and 128 to the UCDBS group. The mean duration of stent patency of the PCDBS (421.2 days; 95% confidence interval [CI], 346.7-495.7) was longer than that of the UCDBS (377.4 days; 95% CI, 299.7-455.0), although total stent dysfunction and stent dysfunction within 6 months were not different between groups. Multivariate analysis indicated that chemotherapy after stent placement was a significant factor for overall survival (hazard ratio, .570; 95% CI, .408-.796) and had a marginal impact on stent patency (hazard ratio, 1.569; 95% CI, .923-2.667). There were no remarkable differences in AEs, including pancreatitis, cholecystitis, and stent migration, between the 2 groups. The use of PCDBSs compared with UCDBSs in patients with distal MBO has unclear benefits regarding stent patency and overall survival, although PCDBSs have a lower rate of tumor ingrowth. (Clinical trial registration number: NCT02937246.).

Covered vs. uncovered self-expandable metal stents for palliation of malignant afferent loop obstruction: a multicenter study

Background and aims Endoscopic stent placement is a palliative therapy for malignant digestive tract obstruction. However, its use for malignant afferent loop obstruction (mALO) has not been adequately investigated. Methods From March 2009 to December 2020, 137 patients with mALO who underwent endoscopic stent placement at three tertiary care centers were retrospectively enrolled. The primary aim of this study was to compare stent dysfunction (SD) between the covered self-expandable metal stent (CSEMS) and uncovered self-expandable metal stent (UCSEMS) groups, with subgroup analysis among patients with extrinsic and intrinsic tumors separately. Results Twenty-three patients developed SD in the CSEMS group and 29 patients in the UCSEMS group (log-rank p = .974). The primary contributors to SD included a higher risk of stent migration in the CSEMS group and stent ingrowth in the UCSEMS group (p = .003; p < .001). Among patients with extrinsic tumors, the CSEMS group showed a significantly higher probability of overall SD (p = .008) and stent migration (p = .001) with a shorter time to SD (log-rank p = .006) than the UCSEMS group. Among patients with intrinsic tumors, the CSEMS group showed a significantly lower incidence of overall SD (p < .001) and stent ingrowth (p < .001) with a longer time to SD (log-rank p = .011) than the UCSEMS group. Conclusions Our results showed no significant difference in SD between the CSEMS and UCSEMS groups for palliation of mALO. Furthermore, subgroup analysis suggested using CSEMSs for patients with intrinsic tumors, and UCSEMSs for those with extrinsic tumors.

Endoscopic placement of covered versus uncovered self-expandable metal stents for palliation of malignant gastric outlet obstruction

ObjectiveStenting is an established endoscopic therapy for malignant gastric outlet obstruction (mGOO). The choice of stent (covered vs uncovered) has been examined in prior randomised studies without clear results.DesignIn a...

S3307 Partially Covered Self-Expanding Metal Stents for Palliation of Malignant Gastric Outlet Obstruction; A Meta-Analysis of Observational Studies

INTRODUCTION: Enteral covered and partially covered self-expanding metal stents (CSEMS, pCSEMS) were designed to improve stent patency and reduce stent migration and are widely used for the palliation of malignant gastric outlet obstruction (MGOO). However, knowledge regarding the safety and efficacy profile of pCSEMS is lacking. METHODS: A comprehensive literature search was performed of Medline(Ovid) and Embase from inception to July 2019. All studies were screened by two authors to identify studies reporting the safety and efficacy of pCSEMS for palliation of MGOO. A logistic-normal random-effects model was applied while pooling data to account for effect sizes close or equal to zero and one. Pooled data was reported as proportions with 95% confidence interval (CI). RESULTS: Screening of 3553 articles yielded 4 studies on pCSEMS enrolling 167 patients. Three studies reported using silicone covered pCSEMS whereas one study did not report cover material type. Technical success rate was 100% (71%–100%) whereas clinical success of was of pCSEMS placement was 90% (84–96%). The pooled adverse event rate was 54% (29%–77%). Stent migration occurred in 8% (5–13%) of patients. Stent collapse/fracture rate was 4% (1–20%). Tumor ingrowth occurred in 0% (0–64%) of pCSEMS, whereas tumor overgrowth occurred in 7% (2–26%) of pCSEMS. Luminal perforation rate was 1% (0–5%). Post–procedural bleeding was reported in 1% (0–5%) of patients. Endoscopic reintervention rate was 23% (10–44%) due to 71% (16–97%) of the reported adverse events. Surgical intervention rate was 2% (1–6%) due to 4% (1–21%) of the adverse events. No adverse event–associated mortality was reported. CONCLUSION: pCSEMS carry a clinical success rate of 90%, making them an efficacious alternative to fully-covered SEMS. The migration rate of pCSEMS was 8%, along with an endoscopic reintervention rate of 23%, a finding that warrants further query. Well-designed studies are needed to validate and build upon our findings. The standard of care for malignant gastric outlet obstruction (MGOO) in the US remains uncovered SEMS; we anticipate our findings can aide investigators as well as policy makers when considering expanded access to CSEMS in the US.Table and Figure 1.: Safety and Efficacy Outcomes of Partially Covered Self-Expanding Metal Stents for Palliation of Malignant Gastric Outlet Obstruction

S0911 Self-Expanding Metal Stents for Palliation of Malignant Gastric Outlet Obstruction: Does Cover Material Matter? A Meta-Analysis

INTRODUCTION: Knowledge regarding the optimal cover material for fully or partially covered self-expanding metal stents (CSEMS) deployed for palliation of malignant gastric outlet obstruction (MGOO) is lacking. METHODS: A comprehensive literature search was performed of Medline (Ovid) and Embase from inception-July 2019. All studies were screened by two authors to identify studies reporting the safety and efficacy of CSEMS for palliation of MGOO with information on CSEMS cover material. A logistic-normal random-effects model was applied while pooling data to account for effect sizes close or equal to zero and one. Pooled data was reported as proportions with 95% confidence interval (CI). RESULTS: Screening of 3553 articles yielded 13 studies (5 on silicone CSEMS, 8 on Polytetrafluoroethylene (PTFE)-CSEMS) enrolling 646 patients (484 with PTFE-CSEMS, 162 with silicone CSEMS). Technical success rate was 99% (95–100%) and 100% (98%–100%) for silicone CSEMS and PTFE-CSEMS. Clinical success of PTFE-CSEMS was 94% (86–97%) which was higher than the clinical success of silicone CSEMS (90%; 82–94%). The pooled adverse event rate for silicone CSEMS and PTFE-CSEMS was 26% (20–32%) and 62% (32–85%), respectively. Stent migration occurred in 17% (11–24%) and 23% (10–36%) of PTFE-CSEMS and silicone CSEMS. Stent collapse/fracture rate was 4% (0–8%) and 5% (1–9%) for PTFE-CSEMS and silicone CSEMS. Tumor ingrowth occurred in 2% (0–4%) and 31% (24–39%) of PTFE-CSEMS and silicone CSEMS. Tumor overgrowth occurred in 4% (1–7%) and 5% (0–9%) of PTFE-CSEMS and silicone CSEMS. Luminal perforation rate was 2% (1–4%) and 1% (0–4%) with PTFE-CSEMS and Silicone CSEMS. Post-procedural bleeding rate was 2% (0–5%) and 1% (0–4%) with PTFE-CSEMS and Silicone CSEMS. Endoscopic reintervention rate was 24% (10–37%) and 29% (0–59%) with PTFE-CSEMS and silicone CSEMS. Surgical intervention rate was 2% (0–5%) and 1% (0–4%) for PTFE-CSEMS and silicone CSEMS. CONCLUSION: A trend towards higher rate of adverse events, particularly stent migration and tumor ingrowth was observed with Silicone CSEMS use upon indirect comparison with PTFE-CSEMS; this may translate into a higher reintervention rate. Further well-designed studies are needed to validate and build upon our findings. The standard of care for MGOO in the US remains uncovered SEMS; we anticipate our findings can aide investigators as well as policy makers when considering expanded access to CSEMS in the US.Table and Figure 1.: Safety and Efficacy Outcomes of Covered Self-Expanding Metal Stent Insertion for the Palliation of Malignant Gastric Outlet Obstruction Stratified by Cover Type

Acute kidney injury due to high-output external biliary drainage in a patient with malignant obstructive jaundice: a case report

BackgroundPersistent high output is a rare but potentially serious complication of percutaneous biliary drainage.Case presentationA 68-year-old Sinhalese woman with a palliative self-expanding metal stent placed for an inoperable hilar cholangiocarcinoma presented with worsening obstructive jaundice. Ultrasonography showed intrahepatic duct dilatation with the self-expanding metal stent in situ. Since this was indicative of a blocked stent, percutaneous transhepatic cholangiogram-guided internal biliary stenting through the self-expanding metal stent was attempted and failed. Therefore, an external biliary drain was left in the dilated biliary system. Post procedure, she developed a high biliary output of 3–4 liters per day and went into oliguric acute kidney injury with metabolic acidosis, most probably due to inadequate fluid replacement and hypovolemia.ConclusionAlthough the mechanism by which this occurs in some cases is unclear, early identification and prompt fluid resuscitation prevent acute kidney injury. The adoption of new strategies for internal drainage of long complex strictures will both prevent and ameliorate this problem.

Efficacy and Safety of Endoscopic Self-Expanding Metallic Stent for Esophageal Malignancy: A Two-Institute Experience

Abstract Background: Self-expandable metallic stents (SEMS) placement is the procedure of choice for palliation of dysphagia in inoperable esophageal malignancies. Aim To evaluate the safety of placement of SEMS in esophageal cancer at two institutes using only endoscopic control without fluoroscopy and to determine efficacy of SEMS in palliation of dysphagia after deployment. Methods: Participants who underwent endoscopy and esophageal SEMS placement at two centers for inoperable esophageal malignancy between 2014 and 2017 were included retrospectively. The indication for the procedure and clinical outcome measures like adverse events and improvement in dysphagia score were recorded on uniform structured data forms. Results: Eighty-three esophageal SEMS placement was performed in 78 patients (mean age 64 ± 10.1 years; 59 men). The indication of SEMS placement was stricture in 72 (92.3%) and in 6 cases SEMS was placed for closure of trachea–esophageal fistula. All the patients in dysphagia score of 3 have improved to lower dysphagia scores post stent deployment. Postprocedure retrosternal pain, respiratory distress, and aspiration pneumonia in 58, 9, and 2 patients, respectively. Five patients required repeat stenting due to tumor ingrowth/granulation tissue during follow-up. The median survival of patients who received SEMS was significantly different from controls who did not receive SEMS (141 [41–360] days versus 98 [30–165 days]; p = 0.01). In 2 cases stent repositioning was done due to distal migration at the time of placement. There was no SEMS migration or stent related complications at follow-up. Conclusions: SEMS can be placed effectively under endoscopic control without fluoroscopic control in palliation of esophageal malignancy. Early SEMS deployment for palliating dysphagia may lead to survival advantage.

Covered versus uncovered self-expandable metal stent for palliation of primary malignant extrahepatic biliary strictures: a randomized multicenter study

Self-expandable metal stents (SEMSs) are used to relieve malignant biliary obstructions. We aimed to compare stent patency, the adverse events rate, and overall survival of covered versus uncovered self-conformable metal stents in patients with primary malignant extrahepatic biliary strictures, not eligible for surgery. This is a multicenter randomized trial analyzing 158 patients with inoperable distal malignant biliary obstruction conducted in 5 Italian referral centers between December 2014 and October 2016. Seventy-eight patients were randomized to receive a fully covered SEMS (FCSEMS), and 80 patients received uncovered SEMSs (USEMSs). Data from 148 (72 FCSEMSs and 76 USEMSs) of 158 patients were analyzed. Median time of stent patency was lower for FCSEMSs (240 days vs 541 days for USEMSs; P= .031). Adverse events occurred with 19 FCSEMSs (26.4%) and 10 USEMSs (13.2%); P= .061. The main causes of FCSEMS dysfunction were migration (7% vs 0% in the USEMS group) and early occlusion mainly because of sludge or overgrowth; late stent occlusion because of tumor ingrowth occurred in 13.2% of patients in the USEMS group. There were no significant differences either in levels of conjugated bilirubin improvement or in overall survival between the FCSEMS and USEMS groups. Median survival was 134 days in the FCSEMS group and 112 days in the USEMS group (P= .23). The number of stent-related adverse events was higher, although not significantly, among patients in the FCSEMS group. FCSEMSs had a significantly higher rate of migration than USEMSs, and stent occlusion occurred earlier. A significant difference in the patency rate was observed in favor of the USEMS group. (Clinical trial registration number: NCT02102984.).

Comparison on the Efficacy between Partially Covered Self-Expandable Metal Stent with Funnel-Shaped Enlarged Head versus Uncovered Self-Expandable Metal Stent for Palliation of Gastric Outlet Obstruction.

Background Shape modification has been one of the methods adopted to improve stent patency but has not always translated into positive outcome. The aim of this study was to compare the efficacy of shape-modified partially covered self-expandable metal stent (SEMS) that has enlarged head versus uncovered SEMS for palliation of gastric outlet obstruction (GOO). Methods A total of 48 patients underwent insertion of either enlarged-head SEMS (n = 24) or uncovered SEMS (uSEMS) (n = 24) for palliation of GOO from July 2009 to July 2016. Patients with inoperable or advanced malignancy were included. Technical feasibility and clinical outcomes were compared. Results Technical success rate was 100% (24/24) and 95.8% (23/24) for enlarged-head SEMS group and uSEMS group, respectively. Clinical success rate was 87.5% (21/24) and 87.0% (20/23) for enlarged-head SEMS group and uSEMS group, respectively. The gastric outlet obstruction scoring system score significantly improved in both groups (p < 0.001 for both). Mean survival was similar between the groups: enlarged-head SEMS group, 99.3 days (range, 19–358 days) versus uSEMS group, 82.1 days (range, 11–231 days) (p = 0.418). The mean stent patency also showed no difference between the groups: enlarged-head SEMS group, 87.1 days (range, 8–358 days) versus uSEMS group, 60.4 days (range, 2–231 days) (p = 0.204). With enlarged-head SEMS, distal migration did not occur, but proximal migration was observed in four cases. Conclusions Distal migration was prevented by shaping the SEMS to have an enlarged head, but improvement in stent patency could not be observed.

Self-expandable metal stent for palliation of malignant dysphagia & quality of life improvement in advanced cancer esophagus: Upper Egypt experience

BackgroundIn advanced cancer esophagus patients, self-expandable metallic stents (SEMS) are utilized to relieve malignant difficulty in swallowing and improve their quality of the life. Retrospectively, we evaluated the efficacy, feasibility, and outcomes of SEMS in palliation of malignant dysphagia in advanced cancer esophagus and its' complications. MethodsWe retrospectively reviewed data of 350 patients with malignant dysphagia due to advanced cancer esophagus from December 2012 to April 2017. They were subjected to esophageal stenting with SEMS in our GIT endoscopy unit, General and Cardiothoracic Surgery departments at Qena and Sohag University Hospitals, Egypt. ResultsThe mean age was 56.34 + 12.44 years ranging from 30 to 85 years, and 264 of them were males. Mean duration of dysphagia was 2.90 months. SEMSs were placed successfully in all cases without major complications; however minor bleeding and retrosternal discomfort were seen. The improvement in the dysphagia score was significant. ConclusionsSEMSs were safe and effective in palliation of malignant dysphagia and improvement of the quality of life in advanced esophageal cancer patients without major complications.

P-151 - Comparison on the efficacy between partially covered self-expandable metal stent with enlarged head versus uncovered self-expandable metal stent for palliation of gastric outlet obstruction

P-151 - Comparison on the efficacy between partially covered self-expandable metal stent with enlarged head versus uncovered self-expandable metal stent for palliation of gastric outlet obstruction

Clinical outcomes of self-expandable metallic stents in palliation of malignant anastomotic strictures: a single center experience

Background: Self-expandable metallic stents (SEMS) are used as the main nonsurgical palliative treatment for malignant gastric outlet obstruction. Metal stents are also used to treat malignant anastomotic obstructions after esophagojejunostomy, gastrojejunostomy and esophagogastrojejunostomy. Methods: This case series reports prospectively the clinical outcomes of SEMS in the palliation of malignant anastomotic strictures caused by recurrent gastric cancer following gastric surgery as oncological curative treatment, in a series of nine consecutive patients, treated between January 2009 and December 2012 in our center. Results : Nine patients (M:F=8:1) were included. The operation was a total gastrectomy with esophagogastrojejunostomy (n=4), subtotal gastrectomy with Billroth-II reconstruction (n=3), and subtotal gastrectomy with esophagogastrostomy (n=2) .The technical and clinical success rates were 88,9 % and 88,9 %, respectively. The reobstruction of the stent, caused by tumor ingrowth, occurred in 1 patient (11,1%) within 1 month after stenting. Stent migration occurred with a covered stent in 1 patient who underwent a subtotal gastrectomy with Billroth-II reconstruction. A case of partial stent migration was easily treated with a second stent. The median survival period was 180 days (range, 30-240 days) and the median stent patency was 45 days (range, 30-90 days). Conclusions: Although the number of the patients treated with SEMS results, in this series, almost small to certainly judge the safety and feasibility of SEMS, we believe that the endoscopic insertion of SEMS seems to be a safe, technically feasible, and effective treatment for the palliation of anastomotic strictures caused by recurrent gastric cancer. The technical and clinical success, and the onset of complications of this procedure are influenced by several factors, such as the type of anastomosis, the technical features of the stent, and the extent of the underlying tumor.

Covered versus uncovered self-expandable metallic stents for palliation of malignant gastric outlet obstruction: a systematic review and meta-analysis.

BackgroundSelf-expandable metallic stents (SEMSs) are widely used for palliation of malignant gastric outlet obstruction (GOO). There are two types of SEMS, covered and uncovered, each with its own advantages and disadvantages. We aimed to compare the efficacy and safety between uncovered and covered SEMSs in the palliation of malignant gastric outlet obstruction.MethodsDatabases including PubMed, EMBASE, the Cochrane Library, the Science Citation Index and momentous meeting abstracts were searched and evaluated by two reviewers independently.ResultsNine trials involving 849 patients were analyzed. Meta-analysis showed there was no significant difference in technical success rate (RR 1.0, 95% CI [0.98, 1.01]), clinical success rate (RR 1.04, 95% CI [0.98, 1.11]), post-stenting dysphagia score (WMD −0.01, 95% CI [−0.52, 0.50]), stent patency (WMD −0.31, 95% CI [−1.73, 1.11]), overall complications (RR 1.07, 95% CI [0.87, 1.32]) and reintervention rate (RR 1.30, 95% CI [0.92, 1.83]) between covered and uncovered SEMSs group. However, covered SEMSs were associated with higher migration rate (RR 3.48, 95% CI [2.16, 5.62], P < 0.00001) and lower obstruction rate (RR 0.42, 95% CI [0.24, 0.73], P = 0.002).ConclusionsIn the palliative treatment of malignant gastric outlet obstruction, both covered and uncovered SEMSs are safely and effective. Covered stents can reduce the risk of restenosis, whereas uncovered stents are effective in decreasing stent migration.

Palliative self-expandable metal stents for acute malignant colorectal obstruction: clinical outcomes and risk factors for complications

Objective. Self-expandable metal stents (SEMSs) have been used as palliative treatment or bridge to surgery for obstructions caused by colorectal cancer (CRC). We assessed the long-term outcomes of palliative SEMSs and evaluated the risk factors influencing complications. Materials and methods. One hundred and seventy-five patients underwent SEMS placement for acute malignant colorectal obstruction. Of the 72 patients who underwent palliative treatment for primary CRC, 30 patients received chemotherapy (CT) for primary cancer (CT group) and 42 underwent best supportive treatment (BST) without CT (BST group). Results. There was a significant difference in late migration between the CT group and the BST group (20.0% in CT group, 2.4% in BST group, p = 0.018). Response to CT influenced the rate of late obstruction (0% in disease control, 35.7% in disease progression, p = 0.014). However, late obstruction was not associated with stent properties, such as diameter or type (≤22 mm vs. >22 mm, 13.5% vs. 14.3%, p = 1.00; uncovered stent vs. covered stent, 15.5% vs. 7.1%, p = 0.675) and migration (≤22 mm vs. >22 mm, 16.2% vs. 2.9%, p = 0.108; uncovered stent vs. covered stent, 8.6% vs. 14.3%, p = 0.615) in palliative SEMS. Conclusion. The administration of CT increases the rate of stent migration, and disease control by CT can reduce the risk of obstruction by maintaining the luminal patency of palliative SEMSs.

Conformable covered versus uncovered self-expandable metallic stents for palliation of malignant gastroduodenal obstruction: A randomized prospective study

A conformable self-expandable metallic stent was developed to overcome the limitation of previous self-expandable metallic stents. The aim of this study was to evaluate outcomes after placement of conformable covered and uncovered self-expandable metallic stents for palliation of malignant gastroduodenal obstruction. A single-blind, randomized, parallel-group, prospective study were conducted in 4 medical centres between March 2009 and July 2012. 134 patients with unresectable malignant gastroduodenal obstruction were assigned to a covered double-layered (n=66) or uncovered unfixed-cell braided (n=68) stent placement group. Primary analysis was performed to compare re-intervention rates between two groups. 120 patients were analysed (59 in the covered group and 61 in the uncovered group). Overall rates of re-intervention were not significantly different between the two groups: 13/59 (22.0%) in the covered group vs. 13/61 (21.3%) in the uncovered group, p=0.999. Stent migration was more frequent in the covered group than in the uncovered group (p=0.003). The tumour ingrowth rate was higher in the uncovered group than in the covered group (p=0.016). The rates of re-intervention did not significantly differ between the two stents. Conformable covered double-layered and uncovered unfixed-cell braided stents were associated with different patterns of stent malfunction.

Status and Literature Review of Self-Expandable Metallic Stents for Malignant Colorectal Obstruction

Use of colorectal stents has increased dramatically over the last decades. Colorectal stents offer an alternative way to relieve fatal intestinal obstruction and can take place of emergency surgery, which associated with significant morbidity and mortality and a high incidence of stoma creation, to elective resection. Although there remain a few concerns regarding the use of stents as a bridge to surgical resection, use of self-expandable metallic stents for palliation in patients with unresectable disease has come to be generally accepted. Advantages of colorectal stents include acute restoration of luminal patency and allowance of time for proper staging and surgical optimization, and the well-known disadvantages are procedure-related complications including perforation, migration, and stent failure. General indications, procedures, and clinical outcomes as well as recent evidences regarding the use of colorectal stents will be discussed in this review.

Late complications related to palliative stenting in patients with obstructing colorectal cancer

Introduction: Self-expanding metal stents (SEMSs) are increasingly used for the palliative treatment of incurable obstructing colorectal cancer. The aim of the current study was to evaluate clinical outcome, including technical and clinical success of stenting, and to identify factors associated with late complications of SEMS in palliation of incurable obstructing colorectal cancer. Material and methods: Between 2003 and 2010 details of 56 patients who underwent an attempt of SEMS insertion for obstructive incurable colorectal cancer at Turku University Hospital were recorded to our database prospectively and analyzed retrospectively. Results: Technical success was achieved in 42 patients (75%) and clinical success in 39 patients (70%). Late complications related to SEMS occurred in 13 patients (31%). Ten patients (24%) needed re-intervention because of a complication: Eight ostomies, one Hartmann´s procedure due to late perforation and one re-stenting because of stent migration. Three patients with stent-related complications were treated conservatively. Chemotherapy and prolonged survival were risk factors for SEMS-related late complications and re-intervention. Conclusion: SEMS insertion is a feasible procedure for the palliative treatment of obstructing colorectal cancer in patients with severe comorbidities and short life expectancy. However, for patients who are candidates for chemotherapy and have a longer life expectancy, other treatment options such as palliative tumor resection should also be considered.