Predictors of clinical outcome of colonic stents in patients with malignant large-bowel obstruction because of extracolonic malignancy

Faraz, Shahdabul; Salem, Suhail B.; Schattner, Mark; Mendelsohn, Robin B.; Markowitz, Arnold J.; Ludwig, Emmy; Zheng, Junting; Gerdes, Hans; Shah, Pari

doi:10.1016/j.gie.2017.12.017

Cited by 39 publications

(48 citation statements)

References 25 publications

(31 reference statements)

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“…The four selected studies have similar characteristics ( Table 1 ) 10 13 23 24 . CSEMS dwelling time ranged from 3 to 6 months and the interval to replace the plastic stents ranged from 6 to 16 weeks.…”

Section: Resultsmentioning

confidence: 99%

“…CSEMS dwelling time ranged from 3 to 6 months and the interval to replace the plastic stents ranged from 6 to 16 weeks. The study by Kaffes et al 6 was the only one that used metallic prostheses with greater diameter at the ends and did not mention minimum follow-up time; the other three studies 10 23 24 reported follow-up of at least 1 year. Data were extracted from published material and there was no need to access original data from the studies.…”

Section: Resultsmentioning

confidence: 99%

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Metallic vs plastic stents to treat biliary stricture after liver transplantation: a systematic review and meta-analysis based on randomized trials

et al. 2018

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Background and study aims The first-line approach to anastomotic biliary stricture after orthotopic liver transplantation (OLTX) involves endoscopic retrograde cholangiopancreatography (ERCP). The most widely used technique is placement of multiple plastic stents, but discussions are ongoing on the benefits of fully-covered self-expandable metallic stents (FCEMS) in this situation. This study aimed to compare results from use of plastic and metal stents to treat biliary stricture after transplantation. Patients and methods Searches were performed in the Medline, EMBASE, SciELO/LILACS, and Cochrane databases, and only randomized studies comparing the two techniques were included in the meta-analysis. Results Our study included four randomized clinical trials totaling 205 patients. No difference was observed between the stricture resolution rate (RD: 0.01; 95 %CI [−0.08 – 0.10]), stricture recurrence (RD: 0.13; 95 %CI [−0.03 – 0.28]), and adverse events (RD: −0.10; 95 %CI [−0.65 – 0.44]) between the plastic and metallic stent groups. The metallic stent group demonstrated benefits in relation to the number of ERCPs performed (MD: −1.86; 95 %CI [−3.12 to −0.6]), duration of treatment (MD: −105.07; 95 %CI [−202.38 to −7.76 days]), number of stents used (MD: −10.633; 95 %CI [−20.82 to −0.44]), and cost (average $ 8,288.50 versus $ 18,580.00, P < 0.001). Conclusions Rates of resolution and recurrence of stricture are similar, whereas the number of ERCPs performed, number of stents used, duration of treatment, and costs were lower in patients treated with FCEMS, which shows that this device is a valid option for initial treatment of post-OLTX biliary stricture.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Metallic vs plastic stents to treat biliary stricture after liver transplantation: a systematic review and meta-analysis based on randomized trials

et al. 2018

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“…Performance metrics during colonoscopy training can be used to indicate readiness for independent practice. The study by Bitar et al 1 is therefore a welcome addition to the colonoscopy training literature. The distinguishing feature of fellow seniority (and presumably competence) was the "efficiency" or speed with which the colon was intubated and adenomas detected and removed.…”

Section: Impact Of Fellowship Training Level On Colonoscopy Quality Amentioning

confidence: 94%

The role of colonic stents in extracolonic malignant large-bowel obstruction

Chen

Fan

Zhao

2019

Gastrointestinal Endoscopy

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To the Editor: Recently, Faraz et al 1 reported that multifocal diseases and peritoneal carcinomatosis were risk factors in the technical and clinical success of stent placement in extracolonic malignant large-bowel obstruction. We would like to raise several concerns about the role of colonic stents in relieving intestinal obstruction. First, stent placement is difficult in cases with extrinsic compression, according to our experience. Stents may easily migrate as a result of intestinal peristalsis. There was only 1 case of stent migration in that study. We ask whether the authors could share more details about stent selection and placement technique. Second, it would be helpful to know the patients' clinical features, including obstruction type, tumor stage, tumor location, and stricture length, along with the technical features of the stent, including length, diameter, type and numbers. 2-4 Lee et al 2 reported that covered stents and full obstruction could negatively affect the clinical outcomes of stent treatment for malignant rectal obstruction. Previous studies suggested that 25 mm was the optimal stent diameter for colonic obstruction. 5,6 Third, small-bowel obstruction also occurs from extracolonic malignancies, accounting for 44% to 52%, 7 but that was not mentioned in this study. For stage 1 or 2 extracolonic malignancies, surgery might be a better choice. Some published studies have reported that stent placement was not always effective for colonic obstruction resulting from extracolonic malignancies. 8,9 As shown, the median survival was only 3.3 months. Were there any therapeutic applications after stent placement? As a palliative approach, was stent placement the better choice for these patients? For patients with extracolonic malignancy, stent indications and outcomes should be further determined. DISCLOSURE All authors disclosed no financial relationships relevant to this publication.

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“…Enteral stenting is more suitable for patients with advanced malignancy who are too sick to undergo surgery, and it could potentially offer a shorter hospital stay with lower medical costs. However, it is less effective in patients with PC in both upper and lower gastrointestinal obstruction with a significant risk of stent failure from tumor ingrowth, inadequate expansion, clogging, or migration [8][9][10][11]. Having predictors of treatment success to identify ideal candidates for enteral stenting is, therefore, critical.…”

Section: Patients and Methods Consecutive Inpatients With Mgiomentioning

confidence: 99%

Palliative treatment for malignant gastrointestinal obstruction with peritoneal carcinomatosis: enteral stenting versus surgery

et al. 2020

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Background and study aims Management of malignant gastrointestinal obstruction (MGIO) is more challenging in the presence of peritoneal carcinomatosis (PC). Outcomes data to guide the management of MGIO with PC are lacking. We aimed to compare the clinical outcomes and adverse events between endoscopic and surgical palliation and identify predictors of stent success in patients with MGIO with PC. Patients and methods Consecutive inpatients with MGIO with PC between 2000 and 2018 who underwent palliative surgery or enteral stenting were included. Clinical success was defined as relief of obstructive symptoms. Results Fifty-seven patients with enteral stenting and 40 with palliative surgery were compared. The two groups did not differ in rates of technical success, 30-day mortality, or recurrence. Clinical success from a single intervention (63.2 % versus 95 %), luminal patency duration (27 days vs. 145 days), and survival length (148 days vs. 336 days) favored palliative surgery (all P < 0.05) but the patients in the surgery group had a trend toward better Eastern Cooperative Oncology Group (ECOG) status. The rate of adverse events (AEs) (10.5 % vs. 50 %), the severity of AEs, and length of hospital stay (4.5 days vs. 9 days) favored enteral stenting (P < 0.05). The need for more than one stent was associated with a higher likelihood of stent failure. Conclusions Our study suggests that enteral stenting is safer and associated with a shorter hospital stay than palliative surgery, although unlike other MGIOs, clinical success is lower in MGIO with PC. Identification of the right candidates and potential predictors of clinical success in ECOG-matched large-scale studies is needed to validate these results.

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Predictors of clinical outcome of colonic stents in patients with malignant large-bowel obstruction because of extracolonic malignancy

Cited by 39 publications

References 25 publications

Metallic vs plastic stents to treat biliary stricture after liver transplantation: a systematic review and meta-analysis based on randomized trials

Metallic vs plastic stents to treat biliary stricture after liver transplantation: a systematic review and meta-analysis based on randomized trials

The role of colonic stents in extracolonic malignant large-bowel obstruction

Palliative treatment for malignant gastrointestinal obstruction with peritoneal carcinomatosis: enteral stenting versus surgery

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