WallFlex colonic stent placement for management of malignant colonic obstruction: a prospective study at two centers

Repici, Alessandro; de, G.; Luigiano, Carmelo; Fabbri, Carlo; Pagano, Nico; Preatoni, Paoletta; Danese, Silvio; Fucci, Lorenzo; Consolo, Pierluigi; Malesci, Alberto; D’Imperio, N.; Cennamo, Vincenzo

doi:10.1016/j.gie.2007.08.019

Cited by 94 publications

(61 citation statements)

References 25 publications

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“…Our overall complication rate was 7.8 % (13 / 167), with 3 % (5 / 167) perforations and 0.6 % (1 / 167) stent-related mortality, which is in line with published overall complication rates (5.3 -5.9 % ) ( 13,17,28 ), perforation rates (3.76 % ) ( 13 ), and mortality rates (0.4 % ) ( 13 ) and signifi cantly lower than published Special attention should be focused on rectal tumors. Sixteen patients with rectal cancer underwent elective surgery in our study, only 2 of whom (12.5 % ) required a stoma to protect a primary anastomosis.…”

Section: Discussionsupporting

confidence: 90%

“…Several articles have been published reporting on the effi cacy and safety of diff erent types of SEMSs as a bridge to surgery procedure in patients with potentially resectable colorectal cancer ( 4,16,17 ). Th e aim of the present study was to evaluate the effi cacy and safety of the WallFlex colonic stent (Boston Scientifi c, Natick, MA) as a bridge to surgery in patients with malignant large-bowel obstruction.…”

Section: Resultsmentioning

confidence: 99%

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Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

Jiménez-Perez

Casellas

García-Cano

et al. 2011

American Journal of Gastroenterology

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OBJECTIVES:To date, this is the largest prospective series in patients with malignant colorectal obstruction to evaluate the effectiveness and safety of colonic self-expanding metal stents (SEMSs) as an alternative to emergency surgery. SEMSs allow restoration of bowel transit and careful tumor staging in preparation for elective surgery, hence avoiding the high morbidity and mortality associated with emergency surgery and stoma creation. METHODS:This report is on the SEMS bridge-to-surgery subset enrolled in two multicenter international registries. Patients were treated per standard of practice, with documentation of clinical and procedural success, safety, and surgical outcomes. RESULTS:A total of 182 patients were enrolled with obstructive tumor in the left colon (85 % ), rectum (11 % ), or splenic fl exure (4 % ). Of these patients, 86 % had localized colorectal cancer without metastasis. Procedural success was 98 % (177 / 181). Clinical success was 94 % (141 / 150). Elective surgery was performed in 150 patients (9 stomas) and emergency surgery in 7 patients for treatment of a complication (3 stomas). The overall complication rate was 7.8 % (13 / 167), including perforation in 3 % (5 / 167), stent migration in 1.2 % (2 / 167), bleeding in 0.6 % (1 / 167), persistent colonic obstruction in 1.8 % (3 / 167), and stent occlusion due to fecal impaction in 1.2 % (2 / 167). One patient died from complications related to surgical management of a perforation.CONCLUSIONS: SEMSs provide an effective bridge to surgery treatment with an acceptable complication rate in patients with acute malignant colonic obstruction, restoring luminal patency and allowing elective surgery with primary anastomosis in most patients.

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Section: Discussionsupporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

Jiménez-Perez

Casellas

García-Cano

et al. 2011

American Journal of Gastroenterology

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“…The authors concluded that the high perforation rate could be either specifically WallFlex-related or enteral-stent-related in patients on chemotherapy. In contrast, one study conducted in the same year as the previously cited randomised trial and using the WallFlex stent was associated with a perforation rate below 5% (19), which is in line with previous studies using other stents (11,14,20). The results of prospective trials and of recent retrospective studies further demonstrated the effectiveness of SEMS in the palliative management of malignant colorectal obstruction (6,7,(12)(13)(14)21).…”

Section: Discussionsupporting

confidence: 82%

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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“…A large number of dedicated colonic SEMS are currently available [8,15,16] ( table 2 ). The ideal SEMS would be with a small-diameter delivery system easy to insert through the colonoscope, flexible enough to conform curvatures and with a strong expansible force to expand to the caliber of the colon [17,18] .…”

Section: Brief Aspect On Current Techniquesmentioning

confidence: 99%

Colonic Stents for the Palliation of Malignant Colonic Obstruction

Štimac

2008

Dig Dis

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Colorectal self-expanding metal stents have revolutionized the palliative treatment of patients with advanced malignancies and those patients who present with acute colon obstruction and who were previously treated with emergent surgical decompression via formation of colostomy. The placement of stents can be fluoroscopically or non-fluoroscopically guided. The use of stents is associated with significant reduction in hospital duration, mortality and medical complications compared to surgery. The most frequent complications are stent malposition and migration, bleeding, colonic perforation and tumor ingrowth and/or overgrowth.

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WallFlex colonic stent placement for management of malignant colonic obstruction: a prospective study at two centers

Cited by 94 publications

References 25 publications

Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

Colonic Stenting as a Bridge to Surgery in Malignant Large-Bowel Obstruction: A Report from Two Large Multinational Registries

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

Colonic Stents for the Palliation of Malignant Colonic Obstruction

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