Ultraflex precision colonic stent placement for palliation of malignant colonic obstruction: a prospective multicenter study

Repici, Alessandro; Fregonese, Diego; Costamagna, Guido; Dumas, R; Kähler, Georg; Meisner, Søren; Giovannini, Marc; Freeman, Jan G.; Petruziello, Lucio; Hervoso, Cristina M.; Comunale, S.; Faroux, Roger

doi:10.1016/j.gie.2007.03.1042

Cited by 84 publications

(44 citation statements)

References 22 publications

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“…184 A third systematic review that included 54 publications, none of which were randomised, found no cases of gastrointestinal haemorrhage in 1192 patients- 185 A retrospective study of 102 stent placements revealed no haemorrhages, but 4 (4%) perforations, 186 and a multicentre prospective study of 44 stent placements revealed one case of haematoma which resolved spontaneously, and no perforations. 187 In a study of 463 colonic stent placements in 447 patients, there were only 2 (0.5%) cases of haemorrhage, but 15 (3.9%) perforations, 3 of which were fatal. 188 In a RCT of colonic stenting versus emergency surgery in the context of acute malignant colonic obstruction there were no instances of haemorrhage in the stenting group, but 6/47 (13%) perforations.…”

Section: Endoscopic Stent Insertionmentioning

confidence: 98%

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Vanbiervliet²,

et al. 2017

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Section: Endoscopic Stent Insertionmentioning

confidence: 98%

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Vanbiervliet²,

et al. 2017

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“…Many earlier series used esophageal stents for colonic stenting and it is hoped that specifically designed colorectal stents will have lower rates of migration. For example, in a prospective study with 44 patients [45] the nitinol Ultraflex precision colonic stent migrated in one patient (2%) who had commenced chemotherapy shortly after stent insertion. There was a technical success rate of 95% and a 6 mo clinical success rate of 81%.…”

Section: Colonic Stentingmentioning

confidence: 99%

Endoscopic stenting-Where are we now and where can we go?

Mcloughlin¹,

Byrne²

2008

WJG

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Self expanding metal stents (SEMS) play an important role in the management of malignant obstructing lesions in the gastrointestinal tract. Traditionally, they have been used for palliation in malignant gastric outlet and colonic obstruction and esophageal malignancy. The development of the polyflex stent, which is a removable self expanding plastic stent, allows temporary stent insertion for benign esophageal d i s e a s e a n d p o s s i b l y fo r p a t i e n t s u n d e r g o i n g neoadjuvant chemotherapy prior to esophagectomy. Potential complications of SEMS insertion include perforation, tumour overgrowth or ingrowth, and stent migration. Newer stents are being developed with the aim of increasing technical and clinical success rates, while reducing complication rates. Other areas of development include biodegradable stents for benign disease and radioactive or drug-eluting stents for malignant disease. It is hoped that, in the future, newer stents will improve our management of these difficult conditions and, possibly, provide prognostic as well as symptomatic benefit in the setting of malignant obstruction.© 2008 The WJG Press. All rights reserved. [9] and improvements in quality of life, dysphagia, and eating scales [10] for brachytherapy. It has been suggested that, as stent re-intervention is likely to be increased for those who live longer, SEMS should be considered for those with a poorer prognosis, and chemo/radiotherapy, with temporary stent placement, for those with a longer life expectancy [2] . A Korean group inserted a removable nitinol stent in 47 patients who had concur rent radiotherapy and extracted the stent in 24 patients after 4 wk, leaving the stent in place in the remaining patients [11] . The complication and re-intervention rates were significantly lower in the group in which the stent was extracted, while the dysphagia-progression-free and overall survival rates were significantly longer. No randomized trials have yet been conducted with the Polyflex stent, which is the only removable stent licensed in the USA in this setting. Further randomized trials of SEMS in combination with other treatment modalities would help determine the optimal management strategy in terms of symptom control and overall survival. Drugeluting and radioactive stents may also have a future role in the management of esophageal malignancy; these have been tested with success in animal models [12,13] . In cases where the distal margin of the stent crosses the gastro-esophageal (GE) junction there are now SEMS available with an anti-reflux mechanism. Survival has been shown to be reduced in patients in whom the stent crossed the GE junction [14] . A study which compared an open stent with the Z-stent with Dua antireflux valve found that 96% of patients with the open stent had reflux symptoms, compared with 12% with the antireflux mechanism [15] . Several other SEMS with antireflux mechanisms have been manufactured. Further work will be required to determine the overall efficacy and complic...

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“…In this group of patients, curative resection is not frequently feasible (4,5). Therefore, palliation is the primary aim in these patients (3,6,7). Emergency surgical decompression is associated with high mortality and morbidity figures (8,9).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, surgery often involves creation of a colostomy, reversal of which would not be possible in up to 50% of patients. This inter- vention would thus have a profound negative impact on quality of life (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction

Liberato

Marques

et al. 2012

Rev. esp. enferm. dig.

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Background: self-expanding metal stents are currently being used as a definitive palliative treatment for malignant colorectal obstruction in patients with incurable disease. Few studies have followed large numbers of patients from stent placement until death, and those few have reported conflicting results in the long-term clinical outcome data.Aims: this study evaluated the clinical effectiveness of stent placement for malignant colorectal obstruction throughout the patients' lives and related factors affecting stent patency, clinical success and complications.Methods: this was a multicentre, retrospective study of 89 consecutive patients who had undergone attempted expandable stent placement for symptomatic malignant colorectal obstruction during a 10-year period. Data were collected to analyse the sustained relief of obstructive symptoms throughout the patients' lives, as well as the technical success, immediate clinical success, stent patency, complications, reinterventions, survival, prognostic factors associated with stent patency and long-term clinical efficacy and risk factors for complications.Results: technical and immediate clinical success were achieved in 95.5% and 91.0% of patients, respectively. A total of 68 out of 89 patients (76.4%) maintained relief of obstruction from stent implantation until death without reintervention. Twenty patients (22.5%) had complications including perforation (n = 4; 4.5%), stent obstruction (n = 8; 9.0%), migration (n = 5; 5.6%) and haemorrhage (n = 3; 3.4%). Stent-related mortality was seen in 1 patient (1.1%). The estimated median survival and estimated mean stent patency were 87.0 and 322.7 days, respectively. In total, 12 of the initial 89 patients (13.5%) needed a colostomy for long-term relief of the obstructive symptoms. Univariate and multivariate analysis detected no significant prognostic factors associated with stent patency, longterm clinical efficacy and risk factors for complications; however, the multivariate logistic model revealed a non-significant trend by which the use of chemotherapy was a risk factor for migration (OR = 11.89; p = 0.06).Conclusions: for palliation of incurable malignant colorectal obstruction, expandable stents can provide sustained relief of obstruction in approximately 75% of patients. The procedure is associated with acceptable morbidity, need for reintervention and minimal mortality.Key words: Self-expanding metal stent. Colorectal obstruction. Endoscopic definitive palliation. INTRODUCTIONColorectal cancer is one of the most common malignancies worldwide (1). In patients with colorectal cancer, obstruction occurs in 15 to 20% (2). Most of these patients have advanced disease and are often elderly, with significant comorbidities (2-4). In this group of patients, curative resection is not frequently feasible (4,5). Therefore, palliation is the primary aim in these patients (3,6,7). Emergency surgical decompression is associated with high mortality and morbidity figures (8,9). In addition, surgery often involves creation of a...

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Ultraflex precision colonic stent placement for palliation of malignant colonic obstruction: a prospective multicenter study

Cited by 84 publications

References 22 publications

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Endoscopic stenting-Where are we now and where can we go?

Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction

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