Safety and Efficacy of Through-the-Scope Placement of Colonic Self-expandable Metal Stents Without Fluoroscopic Guidance: A Retrospective Cohort Study

Abstract

Background: Colonic self-expandable metal stents (SEMSs) are usually placed through an endoscope under fluoroscopic guidance. In this retrospective study, we measured the safety and efficacy of through-the-scope colonic stent placement without fluoroscopic guidance. Materials and Methods: We included consecutive patients with malignant colonic obstruction who underwent SEMS placement through the endoscope without fluoroscopic guidance (NF group) from 2016 to June 2019 in a single tertiary medical center. Technical and clinical success rates and complication rates were compared with those of a historical control group consisting of consecutive patients who underwent stent placement through the endoscope under fluoroscopic guidance (F group) from 2012 to 2015. Results: Of 136 patients analyzed, 67 were in the NF group and 69 were in the F group. For the NF and F groups, technical success rates were 97.0% and 95.7%, respectively (P=0.763); clinical success rates were 92.5% and 89.9%, respectively (P=0.581). Major complications included perforation (NF group, 1.5%; F group, 1.4%), stent migration (NF group, 0; F group, 1.4%), and stent occlusion (NF group, 1.5%; F group, 2.9%) (P=0.425). The median procedure time was significantly lower in the NF group (25.90±18.68 min) than in the F group (44.23±20.40 min) (P<0.001). Conclusions: Colonic SEMS placement without fluoroscopy is as safe and effective as the conventional fluoroscopically guided approach. This new method significantly reduced the procedure time.

A case report of colonic stent placement without X-ray control in the COVID-19 era: a practical method or a mistake?

“…This approach can be useful in emergency settings and accommodates the optimal management of a patient's condition by decompressing the obstruction and allowing the passage of stools and gases in the safest way. A retrospective study by Zhou et al in 2020 demonstrated that colonic stent placement without fluoroscopy is as safe and effective as the conventional, fluoroscopically-guided approach (1). According to the recommendations of the European Society of Gastrointestinal Endoscopy (ESGE), colonic stenting should be performed with the combined use of endoscopy and fluoroscopy (2).…”