Self-Expanding Metallic Stents (SEMS) in Left-Sided Colonic Cancer—a Cancer Center Experience

Saeed, Kamran; Zafar, Waleed; Masood, Muhammad Adnan; Khattak, Shahid; Syed, Aamir Ali; Yusuf, Muhammed Aasim

doi:10.1007/s12029-015-9789-x

Cited by 5 publications

(4 citation statements)

References 17 publications

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“… 7 , 12 Metallic stents, which have traditionally been used for palliation, now are recommended as a bridge to surgery for resectable obstructing colorectal tumours. 4 , 13 A meta-analysis by Allievi et al . 7 compared the use of stents with emergency surgery and found that use of the former was associated with a shorter hospital stay, helped to convert emergency to elective surgery, increased the likelihood of primary anastomosis, avoided surgery prior to diagnosis or staging, and was associated with better quality of life.…”

Section: Discussionmentioning

confidence: 99%

Metallic stent insertion to relieve malignant bowel obstruction in a child: a case report

Bilal

Saeed

Sidique

et al. 2022

Clin Med Insights Gastroenterol

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Self-expandable metallic stents (SEMS) have been widely used in adults to relieve obstruction secondary to colorectal tumours. However, there is a paucity of literature about their use in children, with only a few case reports describing stent insertion in children with benign colonic conditions. There is one case report on a malignant colonic condition in a child by Hussain et al. in the literature. However, due to the rarity of the condition, there are currently no guidelines from learned societies on colorectal SEMS placement in paediatric patients. We share our experience of using a fully covered SEMS to relieve malignant colonic obstruction in a 6 year-old-child, who was on treatment for T cell lymphoma. This was done as a bridge to surgery, thereby allowing planned surgery, and avoiding colostomy in this child, who went on to have colonic resection with primary anastomosis.

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Section: Discussionmentioning

confidence: 99%

Metallic stent insertion to relieve malignant bowel obstruction in a child: a case report

Bilal

Saeed

Sidique

et al. 2022

Clin Med Insights Gastroenterol

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“…The most common and feared complication of SEMS insertion is local perforation, an event that has been reported to occur in the literature at a rate of 4%‐13% 22,23 . We reported a 9% rate of this complication in our series of patients, and found a nonsignificant, but positive, association between its occurrence and serum low haemoglobin levels: such an association might be explained by the fact that low haemoglobin concentration in the circulation is a hallmark of poor well‐being of patients, which in turn is usually a predisposing factor for any complication.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic stenting for colorectal cancer obstruction as a bridge‐to‐surgery strategy

Lovero

Losurdo

Fortezza

et al. 2020

Eur J Clin Investigation

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Background Acute obstructive colorectal cancer requires prompt decompression commonly by emergency surgery (ES). However, self‐expanding metal stents (SEMS) have been increasingly used as a bridge‐to‐surgery (BTS) strategy. Materials and methods In an 8‐year period, consecutive patients with acute left‐sided colonic obstruction, due to locally advanced colorectal cancer, underwent ES or SEMS implantation. We evaluated technical/clinical success of SEMS, adverse events, and overall (OS) and disease‐free survival (DFS) of the two therapeutic options. Results Forty‐five patients underwent ES (n = 23) or SEMS (n = 22). The two groups were comparable for sex, age, ASA score and cancer site/stage. Technical and clinical successes of SEMS were 100% and 72.7%, respectively. Clinical success correlated with neutrophil‐lymphocyte ratio (NLR) at baseline (OR = 0.65, 95% CI 0.43‐0.98, P = .04). SEMS allowed primary anastomosis in the 45.5% of cases (0% in ES). SEMS implantation allowed a higher rate of surgery carried out by a laparoscopic approach: 36.4% vs 13.0% in ES. Performance of a definitive stoma and complications were similar. Median OS (34 in SEMS; 45 in ES, P = .33) and DFS (36 in SEMS; 35 in ES, P = .35) did not differ between the two groups. At univariate analysis, DFS was positively associated with primary anastomosis (HR = 2.44, 95% CI 1.4‐16.6, P = .04) and laparoscopic surgery (HR = 8.33, 95% CI 1.08‐50, P = .04), and inversely associated with a NLR > 3.6 (HR = 0.59, 95% CI 0.16‐0.92, P = .03). At multivariate analysis, no feature retained an independent predictive power. Conclusion SEMS is an effective and safe procedure, equivalent to emergency surgery in terms of complications, OS and DFS, providing the chance of a primary anastomosis in the majority of patients.

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“…164 With respect to colonic SEMS, a large prospective series of 513 patients and 6 retrospective studies found the risk of clinically relevant haemorrhage within 7 days to be 0%. [165][166][167][168][169][170][171][172][173][174] A systematic review identifying 40 studies on SEMS for the management of emergency malignant large bowel obstruction identified 9 studies reporting on clinical relevant bleeding which occurred in 0.5% (8 out of 1474 patients). 175 We have considered endoscopic stenting at all sites in the GI tract to be low risk for haemorrhage within 7 days.…”

Section: Endoscopic Stentingmentioning

confidence: 99%

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

Veitch

Radaelli

Alikhan

et al. 2021

Gut

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This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.

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Self-Expanding Metallic Stents (SEMS) in Left-Sided Colonic Cancer—a Cancer Center Experience

Abstract: SEMS insertion for left-sided malignant colonic obstruction is a safe and effective procedure when used either as a bridge to surgery or with palliative intent.

Cited by 5 publications

References 17 publications

Metallic stent insertion to relieve malignant bowel obstruction in a child: a case report

Metallic stent insertion to relieve malignant bowel obstruction in a child: a case report

Endoscopic stenting for colorectal cancer obstruction as a bridge‐to‐surgery strategy

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

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