Abstract
Backgrounds and aims
Self-expanding metal stents (SEMS) have been used as a palliative treatment for malignant colorectal obstruction. However, the reports about primary stent patency rate and associated factors have been limited. This study was performed to evaluate clinical outcomes and factors associated with long-term complications and patency of SEMS in patients with malignant colorectal obstruction.
Materials and methods
Patients who underwent palliative endoscopic placement with uncovered SEMS for a malignant colorectal obstruction were prospectively enrolled at Seoul National University Hospital between April 2005 and August 2007.
Results
Forty-nine patients underwent 51 SEMS placements. Obstruction sites were rectum in 15 patients (30.6%), descending or sigmoid colon in 25 (51.0%), and transverse colon in nine (18.4%), respectively. The causes of obstruction were colorectal cancer in 36 patients (73.5%), direct invasion of gastric cancer in seven (14.3%) and others in six (12.2%). Technical success was achieved in 100% and clinical success in 86%, and there was one procedure-related perforation. Re-obstruction and migration occurred in 16% and 6%, respectively, during mean follow-up period of 331 days. Median stent patency duration was 204 days, and patency rates at 30, 90, and 180 days were 91.2%, 81.0%, and 53.3%, respectively, which was not associated with patient demographics, site of obstruction, or palliative chemotherapy.
Conclusion
Endoscopic SEMS placement is a safe and effective palliative treatment for malignant colorectal obstruction, and overall long-term complication and patency were favorable irrespective of the palliative chemotherapy.
Similar content being viewed by others
References
Khot UP, Lang AW, Murali K, Parker MC (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89:1096–1102
Bhardwaj R, Parker MC (2003) Palliative therapy of colorectal carcinoma: Stent or surgery? Colorectal Dis 5:518–521
Karadag A, Mentes BB, Uner A, Irkorucu O, Ayaz S, Ozkan S (2003) Impact of stomatherapy on quality of life in patients with permanent colostomies or ileostomies. Int J Colorectal Dis 18:234–238
Baron TH (2001) Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 344:1681–1687
Dohmoto M (1991) New method: Endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Dig 3:1507–1512
Baron TH (2005) Colonic stenting: Technique, technology, and outcomes for malignant and benign disease. Gastrointest Endosc Clin N Am 15:757–771
Garcia-Cano J, Gonzalez-Huix F, Juzgado D et al (2006) Use of self-expanding metal stents to treat malignant colorectal obstruction in general endoscopic practice (with videos). Gastrointest Endosc 64:914–920
Soto S, Lopez-Roses L, Gonzalez-Ramirez A, Lancho A, Santos A, Olivencia P (2006) Endoscopic treatment of acute colorectal obstruction with self-expandable metallic stents: experience in a community hospital. Surg Endosc 20:1072–1076
Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M (2004) Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99:2051–2057
Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ (2007) Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 246:24–30
Jost RS, Jost R, Schoch E, Brunner B, Decurtins M, Zollikofer CL (2007) Colorectal stenting: An effective therapy for preoperative and palliative treatment. Cardiovasc Intervent Radiol 30:433–440
Baron TH, Rey JF, Spinelli P (2002) Expandable metal stent placement for malignant colorectal obstruction. Endoscopy 34:823–830
Deans GT, Krukowski ZH, Irwin ST (1994) Malignant obstruction of the left colon. Br J Surg 81:1270–1276
Umpleby HC, Williamson RC (1984) Survival in acute obstructing colorectal carcinoma. Dis Colon Rectum 27:299–304
Fielding LP, Phillips RK, Hittinger R (1989) Factors influencing mortality after curative resection for large bowel cancer in elderly patients. Lancet 1:595–597
Pothuri B, Guirguis A, Gerdes H, Barakat RR, Chi DS (2004) The use of colorectal stents for palliation of large-bowel obstruction due to recurrent gynecologic cancer. Gynecol Oncol 95:513–517
Vitale MA, Villotti G, d'Alba L, Frontespezi S, Iacopini F, Iacopini G (2006) Preoperative colonoscopy after self-expandable metallic stent placement in patients with acute neoplastic colon obstruction. Gastrointest Endosc 63:814–819
Mucci-Hennekinne S, Kervegant AG, Regenet N et al (2007) Management of acute malignant large-bowel obstruction with self-expanding metal stent. Surg Endosc 21:1101–1103
Ptok H, Marusch F, Steinert R, Meyer L, Lippert H, Gastinger I (2006) Incurable stenosing colorectal carcinoma: endoscopic stent implantation or palliative surgery? World J Surg 30:1481–1487
Tilney HS, Lovegrove RE, Purkayastha S et al (2007) Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 21:225–233
Lee KM, Shin SJ, Hwang JC et al (2007) Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction. Gastrointest Endosc 66:931–936
Choi JS, Choo SW, Park KB et al (2007) Interventional management of malignant colorectal obstruction: Use of covered and uncovered stents. Korean J Radiol 8:57–63
Telford JJ, Carr-Locke DL, Baron TH et al (2004) Palliation of patients with malignant gastric outlet obstruction with the enteral wallstent: outcomes from a multicenter study. Gastrointest Endosc 60:916–920
Ptok H, Meyer F, Marusch F et al (2006) Palliative stent implantation in the treatment of malignant colorectal obstruction. Surg Endosc 20:909–914
Tomiki Y, Watanabe T, Ishibiki Y et al (2004) Comparison of stent placement and colostomy as palliative treatment for inoperable malignant colorectal obstruction. Surg Endosc 18:1572–1577
Song HY, Kim JH, Shin JH et al (2007) A dual-design expandable colorectal stent for malignant colorectal obstruction: results of a multicenter study. Endoscopy 39:448–454
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Im, J.P., Kim, S.G., Kang, H.W. et al. Clinical outcomes and patency of self-expanding metal stents in patients with malignant colorectal obstruction: a prospective single center study. Int J Colorectal Dis 23, 789–794 (2008). https://doi.org/10.1007/s00384-008-0477-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-008-0477-1