Severe Complications Limit Long-Term Clinical Success of Self-Expanding Metal Stents in Patients With Obstructive Colorectal Cancer

Fernández‐Esparrach, Glòria; Bordas, J.M.; Giráldez, Miriam; Ginès, Pere; Pellisé, M; Sendino, Oriol; Martínez-Pallí, Graciela; Castells, Antoni; Llach, Joan

doi:10.1038/ajg.2009.660

Cited by 153 publications

(119 citation statements)

References 19 publications

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“…In this setting, colonic stents represent the best option when skills are available [7] . [18] 2008 51 51 (100) 43 (84.3) 1 (1.9) Fernández-Esparrach et al [19] 2010 47 44 (94) 44 (94) 3 (7) Small et al [20] 2010 233 224 (96.1) 222 (95.2) 18 (7.7) Park et al [21] 2010 151 149 (98.6) 140 (92.7) 0 Branger et al [22] 2010 93 86 (92.5) 80 (86) 3 (3.2) Donnellan et al [23] 2010 43 40 (93) 40 (93) 2 (4.6) Lee JH et al [24] 2010 46 46 (100) 39 (84.8) 2 (4.3) Lee HJ et al [25] 2011 71 68 (95.8) 68 (94) 4 (5.6) Luigiano et al [26] 2011 39 36 (92.3) 35 (89.7) 2 (5.1) Jiménez-Pérez et al [27] 2011 182 177 (98) 141 (94) 5 (3) Tominaga et al [28] 2012 24 24 (100) 20 (83) 0 Yoshida et al [29] 2013 33 33 (100) 32 (97) 0 Bonfante et al [30] …”

Section: Resultsmentioning

confidence: 99%

Colorectal stenting as first-line treatment in acute colonic obstruction

García-Cano

2013

WJGE

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Tumoral obstructions in almost the entire gastrointestinal tract can be resolved with interventional digestive endoscopy techniques. Self-expanding metal stent (SEMS) insertion in the obstructed colon is a minimally invasive and relatively simple procedure providing an effective first-line treatment for relief of acute malignant obstruction symptoms and serving either as a preoperative or "bridge to surgery" procedure or as palliative definitive care. This technique was introduced in the early 1990s. Although there is still debate about its real value, a lot of reports have been published since then and the procedure is advocated by many surgical groups as the method of choice for the initial treatment of left-sided tumoral colonic obstruction. Before the procedure, colonic obstruction has to be diagnosed by abdominal radiographs, water contrast enema and/or a computed tomography scan. The greatest information is provided by the latter and it is perhaps the method of choice prior to stenting. Skills and training are mandatory, as in all interventional procedures. The key step for success is to cross the malignant stricture with a guidewire. Care must be taken not to over insufflate an obstructed colon during the procedure. SEMS slide over the guidewire through the endoscope working channel or in parallel, outside the endoscope. An average 7% perforation rate has been reported during the procedure and other minor complications can appear in the follow up. However, as a whole, this technique seems to compare favorably with surgery.

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Section: Resultsmentioning

confidence: 99%

Colorectal stenting as first-line treatment in acute colonic obstruction

García-Cano

2013

WJGE

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“…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%

“…Some 1–17 per cent of patients with a stent develop recurrent obstruction due to tumour ingrowth5 17, 18, 19. The options for further treatment at this stage are either surgery or reinsertion of a second stent within the first.…”

Section: Introductionmentioning

confidence: 99%

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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“…15,55 Early perforation necessitates emergency surgery and may be associated with high mortality (reported as 50% in prospective and retrospective studies. 56,57 Stent migration and re-obstruction (caused by either tumour in-growth or inadequate stent expansion) can usually be managed endoscopically. Stentin-stent placement has reported success rates of 75% to 86% but there is a lack of data on long-term outcomes.…”

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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Severe Complications Limit Long-Term Clinical Success of Self-Expanding Metal Stents in Patients With Obstructive Colorectal Cancer

Cited by 153 publications

References 19 publications

Colorectal stenting as first-line treatment in acute colonic obstruction

Colorectal stenting as first-line treatment in acute colonic obstruction

Impact of restenting for recurrent colonic obstruction due to tumour ingrowth

Colonic cancer: The current role of stent insertion

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