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CardioVascular and Interventional Radiology

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01-10-2016 | Clinical Investigation

Technical and Clinical Outcomes Following Colonic Stenting: A Seven-Year Analysis of 268 Procedures

Authors: M. W. Little, T. Oakley, J. H. Briggs, J. A. Sutcliffe, A. K. Allouni, G. Makris, M. J. Bratby, C. R. Tapping, R. Patel, A. Wigham, S. Anthony, J. Phillips-Hughes, R. Uberoi

Published in: CardioVascular and Interventional Radiology | Issue 10/2016

Abstract

Aims

To assess the factors contributing to the technical and clinical success of colorectal stenting for large bowel obstruction.

Methodology

268 cases of colonic stenting for large bowel obstruction were performed in 249 patients of mean age of 72 years (28–98) between 2006 and 2013. The majority of strictures were due to malignant disease, 244/268 (91 %). Diverticular strictures accounted for 24/268 (9 %).

Results

Overall technical success rate was 81 % (217/268), with a clinical success rate of 65 % (174/268). Duration of symptoms ranged from 0 to 180 days (mean 8 days). Technical success rate was seen to decrease with increasing symptom duration. For symptom duration of less than 1 week, technical success was 85.4 % (181/212) versus 69.6 % (39/56) for those with symptoms of greater than a week (p < 0.05). Clinical success rates fell from 71.3 % (107/150) to 59.3 % (70/118) (p < 0.05) when attempting to stent lesions of greater than 5 cm. There was also a significant reduction in clinical success when stenting lesions on a bend rather than a straight segment of colon 75.7 % (109/144) versus 59.7 % (74/124) (p < 0.05). A total of 20 (7.46 %) perforations were identified during the study. Stent migration occurred in 6.6 % of cases. In-stent stenosis occurred in 3.3 %. The overall 30-day all cause mortality rate was 9 %.

Conclusion

Lesion size, location and duration of obstructive symptoms are statistically significant determinants of patient outcome. These factors could be used to advise patient selection for colonic stenting or direct progression to surgical intervention.

Bowel cancer statistics (Internet): Cancer Research UK. 2015. http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer. Cited 6 Feb 6.

Williams D, Law R, Pullyblank AM. Colorectal stenting in malignant large bowel obstruction: the learning curve. Int J Surg Oncol. 2011;2011:917848.PubMed

Kim EJ, Kim YJ. Stents for colorectal obstruction: past, present, and future. World J Gastroenterol. 2016;22(2):842–52.CrossRefPubMedPubMedCentral

Martinez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Deballón P, Moreno-Azcoita M. Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum. 2002;45(3):401–6.CrossRefPubMed

Griffith RS. Preoperative evaluation. Medical Obstacles to Surgery. Cancer. 1992;70(5 Suppl):1333–41.CrossRefPubMed

Tekkis PP, Kinsman R, Thompson MR, Stamatakis JD. Association of Coloproctology of Great Britain, Ireland. The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg. 2004;240(1):76–81.CrossRefPubMedPubMedCentral

Davila RE, Rajan E, Adler D, Hirota WK, Jacobson BC, Leighton JA, et al. ASGE guideline: the role of endoscopy in the diagnosis, staging, and management of colorectal cancer. Gastrointest Endosc. 2005;61(1):1–7.CrossRefPubMed

Van Halsema EE, van Hooft JE, Small AJ, Baron TH, García-Cano J, Cheon JH, et al. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc. 2014;79(6):970–82 (quiz 983.e2, 983.e5).CrossRefPubMed

Currie A, Christmas C, Aldean H, Mobasheri M, Bloom ITM. Systematic review of self-expanding stents in the management of benign colorectal obstruction. Colorectal Dis. 2014;16(4):239–45.CrossRefPubMed

10.

Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc. 2010;71(3):560–72.CrossRefPubMed

11.

Kumar V, Fausto N, Abbas A. Robbins & cotran pathologic basis of disease. 7th ed. Philadelphia: Saunders; 2004. p. 1525.

12.

Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004;99(10):2051–7.CrossRefPubMed

13.

Cennamo V, Fuccio L, Mutri V, Minardi ME, Eusebi LH, Ceroni L, et al. Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy? Clin Gastroenterol Hepatol. 2009;7(11):1174–6.CrossRefPubMed

14.

Manes G, de Bellis M, Fuccio L, Repici A, Masci E, Ardizzone S, et al. Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent: analysis of results and predictors of outcomes in a large multicenter series. Arch Surg. 2011;146(10):1157–62 (Chic Ill 1960).CrossRefPubMed

15.

Branger F, Thibaudeau E, Mucci-Hennekinne S, Métivier-Cesbron E, Vychnevskaia K, Hamy A, et al. Management of acute malignant large-bowel obstruction with self-expanding metal stent. Int J Colorectal Dis. 2010;25(12):1481–5.CrossRefPubMed

16.

Suh JP, Kim SW, Cho YK, Park JM, Lee IS, Choi M-G, et al. Effectiveness of stent placement for palliative treatment in malignant colorectal obstruction and predictive factors for stent occlusion. Surg Endosc. 2010;24(2):400–6.CrossRefPubMed

17.

Lopera JE, De Gregorio MA. Fluoroscopic management of complications after colorectal stent placement. Gut Liver. 2010;4(Suppl 1):S9–18.CrossRefPubMedPubMedCentral

18.

Moon CM, Kim TI, Lee MS, Ko BM, Kim HS, Lee K-M, et al. Comparison of a newly designed double-layered combination covered stent and D-weave uncovered stent for decompression of obstructive colorectal cancer: a prospective multicenter study. Dis Colon Rectum. 2010;53(8):1190–6.CrossRefPubMed

19.

Lee KM, Shin SJ, Hwang JC, Cheong JY, Yoo BM, Lee KJ, et al. Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction. Gastrointest Endosc. 2007;66(5):931–6.CrossRefPubMed

20.

Gorissen KJ, Tuynman JB, Fryer E, Wang L, Uberoi R, Jones OM, et al. Local recurrence after stenting for obstructing left-sided colonic cancer. Br J Surg. 2013;100(13):1805–9.CrossRefPubMed

21.

Olmi S, Scaini A, Cesana G, Dinelli M, Lomazzi A, Croce E. Acute colonic obstruction: endoscopic stenting and laparoscopic resection. Surg Endosc. 2007;21(11):2100–4.CrossRefPubMed

22.

Ng KC, Law WL, Lee YM, Choi HK, Seto CL, Ho JWC. Self-expanding metallic stent as a bridge to surgery versus emergency resection for obstructing left-sided colorectal cancer: a case-matched study. J Gastrointest Surg. 2006;10(6):798–803.CrossRefPubMed

23.

Dulucq J-L, Wintringer P, Beyssac R, Barberis C, Talbi P, Mahajna A. One-stage laparoscopic colorectal resection after placement of self-expanding metallic stents for colorectal obstruction: a prospective study. Dig Dis Sci. 2006;51(12):2365–71.CrossRefPubMed

Title: Technical and Clinical Outcomes Following Colonic Stenting: A Seven-Year Analysis of 268 Procedures
Authors: M. W. Little
T. Oakley
J. H. Briggs
J. A. Sutcliffe
A. K. Allouni
G. Makris
M. J. Bratby
C. R. Tapping
R. Patel
A. Wigham
S. Anthony
J. Phillips-Hughes
R. Uberoi
Publication date: 01-10-2016
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 10/2016
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-016-1391-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Technical and Clinical Outcomes Following Colonic Stenting: A Seven-Year Analysis of 268 Procedures

Abstract

Aims

Methodology

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Aims

Methodology

Results

Conclusion

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