Predictors of outcome in palliative colonic stent placement for malignant obstruction

Abbott, S.; Eglinton, Tim; Ma, Yanpeng; Stevenson, Christopher; Robertson, G. M.; Frizelle, Frank

doi:10.1002/bjs.9340

Cited by 50 publications

(36 citation statements)

References 31 publications

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“…The technique of stent insertion has been described previously4. Briefly, under light sedation or general anaesthetic the endoscope was introduced to the point of obstruction.…”

Section: Methodsmentioning

confidence: 99%

“…Earlier studies2 3 on stenting suggested a high rate of perforation, although more recent series4, 5, 6, 7 have demonstrated an acceptably low level of complications and high clinical success rates. Compared with palliative surgery, stenting has a lower clinical success rate but a shorter stay in hospital, a reduction in complications, reduced stoma formation, earlier commencement of chemotherapy and improved quality of life8, 9, 10, 11, 12, 13, 14.…”

Section: Introductionmentioning

confidence: 97%

“…As a result of advances in chemotherapy, the life expectancy of patients with metastatic colorectal cancer is increasing15; the median survival of patients after colonic stenting is 7–20 months4 7, 16 17. Some 1–17 per cent of patients with a stent develop recurrent obstruction due to tumour ingrowth5 17, 18, 19.…”

Section: Introductionmentioning

confidence: 99%

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Impact of restenting for recurrent colonic obstruction due to tumour ingrowth

et al. 2017

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BackgroundEndoscopic stenting is used to palliate malignant large bowel obstruction. A proportion of patients will develop recurrent obstruction due to tumour ingrowth and require reintervention. This study aimed to assess the outcome (clinical success and complication rates) of endoscopic reintervention compared with surgical intervention in patients with stent obstruction due to tumour ingrowth.MethodsThis was an observational study using data from a database of patients who underwent palliative colonic stenting between January 1998 and March 2017 at Christchurch Public Hospital.ResultsA total of 190 patients underwent colonic stent insertion, for palliation in 182 cases. Reintervention was performed in 55 (30·2 per cent). Thirty‐one patients (17·0 per cent) developed obstruction within the stent at a median of 4·6 (i.q.r. 2·3–7·7) months after the procedure. Of these, 21 had endoscopic restenting and ten underwent surgery. Restenting had technical and clinical success rates of 100 per cent, and involved a significantly shorter length of stay compared with surgery (median 2 (i.q.r. 1–4) versus 11 (6–19) days respectively; P = 0·006). Seven of the 21 patients in the restented group underwent a third palliative intervention. The overall stoma rate in the restented group was significantly lower than that in the surgical group (4 of 21 versus 10 of 10; P < 0·001). There was no difference in complications or survival between the two groups.ConclusionAmong palliative patients who develop malignant stent obstruction, endoscopic restenting had a high chance of technical success. It resulted in a shorter hospital stay and lower stoma rate than those seen after surgery.

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“…The technique of stent insertion has been described previously4. Briefly, under light sedation or general anaesthetic the endoscope was introduced to the point of obstruction.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

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Impact of restenting for recurrent colonic obstruction due to tumour ingrowth

et al. 2017

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“…Shorter hospitalization and better 30-day mortality rate in SEMS use allows earlier start of chemotherapy treatment. Early evidence regarding chemotherapy use in stented patients was contradictory 21,58 but there was concern that chemotherapy use may increase perforation rate. Retrospective series suggested an increased perforation rate in those treated with bevacizumab (an angiogenesis inhibitor) (17%-50%).…”

Section: Palliative Semsmentioning

confidence: 99%

Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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Acute colonic obstruction secondary to left-colonic malignancy remains a common emergency condition. Traditional management is emergency surgery and has high morbidity and mortality. Self expandable metallic stents (SEMS) promised to improve morbidity and mortality, stoma rates and hospital stay. SEMS use in the potentially curative setting, as a bridge to surgery, is associated with an improved stoma rate and morbidity, but has no mortality benefit. There are concerns about oncological safety with higher local recurrence rates, thus SEMS is not recommended in this setting unless the patient has increased surgical risk and would benefit from a period of recovery prior to surgery. SEMS has a definite role in the palliative setting, for both patients with incurable disease or those with a high surgical risk. SEMS is associated with improved morbidity, mortality, and stoma rates. The technique for SEMS insertion is now well established but it is still unclear whether covered or uncovered stents are better.

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“…30,31 Improved survival may paradoxically result in a higher re-intervention rate, as there is more time for tumor to grow into the interstices or over the ends of the stent. 32,33 The use of covered stents reduced stent occlusion as low as 0% in some studies. 26 Nonetheless, this benefit seems to be balanced by an increased migration rate.…”

Section: Stent Failure Stent Migrationmentioning

confidence: 99%

Enteral stent construction: Current principles

Laasch

Edwards

Song

2016

Int J Gastrointest Interv

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A B S T R A C TThe insertion of self-expanding stents into malignant strictures of the small and large bowel has become a routine procedure around the world. However, stent development has happened very much on a "trial & error" approach, based mostly on bright ideas of enthusiastic individuals or marketing decisions by the manufacturer. A large variety of stents are commercially available, covered to a variable degree by a membrane to reduce tissue ingrowth. However, in vitro characteristics and in vivo behavior vary significantly between stents and few operators are aware of the differences. While the ideal stent still remains to be defined, it is important that interventionists understand the variations, in order to make the best possible choice for the individual patient. This article illustrates current principles of stent construction.

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Predictors of outcome in palliative colonic stent placement for malignant obstruction

Abstract: SEMS offer a valid alternative to operative intervention in the palliative management of malignant large bowel obstruction. Patients receiving chemotherapy are more likely to receive endoscopic reintervention, which is largely successful.

Cited by 50 publications

References 31 publications

Impact of restenting for recurrent colonic obstruction due to tumour ingrowth

Impact of restenting for recurrent colonic obstruction due to tumour ingrowth

Colonic cancer: The current role of stent insertion

Enteral stent construction: Current principles

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