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Mauro A, Scalvini D, Borgetto S, Fugazzola P, Mazza S, Perretti I, Gallotti A, Pagani A, Ansaloni L, Anderloni A. Malignant Acute Colonic Obstruction: Multidisciplinary Approach for Endoscopic Management. Cancers (Basel) 2024; 16:821. [PMID: 38398212 PMCID: PMC10887189 DOI: 10.3390/cancers16040821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Patients presenting with acute colonic obstruction are usually evaluated in the emergency department and multiple specialties are involved in the patients' management. Pre-treatment evaluation is essential in order to establish the correct endoscopic indication for stent implantation. Contrast-enhanced imaging could allow the exclusion of benign causes of colonic obstruction and evaluation of the length of malignant stricture. Endoscopic stenting is the gold standard of treatment for palliative indications whereas there are still concerns about its use as a bridge to surgery. Different meta-analyses showed that stenting as a bridge to surgery improves short-term surgical outcomes but has no role in improving long-term outcomes. Multidisciplinary evaluation is also essential in patients that may be started on or are currently receiving antiangiogenic agents because endoscopic stenting may increase the risk of perforation. Evidence in the literature is weak and based on retrospective data. Here we report on how to correctly evaluate a patient with acute colonic malignant obstruction in collaboration with other essential specialists including a radiologist, surgeon and oncologist, and how to optimize the technique of endoscopic stenting.
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Affiliation(s)
- Aurelio Mauro
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Davide Scalvini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
- Department of Internal Medicine, PhD in Experimental Medicine Italy, University of Pavia, 27100 Pavia, Italy
| | - Sabrina Borgetto
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paola Fugazzola
- Department of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Stefano Mazza
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Ilaria Perretti
- Institute of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Anna Gallotti
- Institute of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Anna Pagani
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Luca Ansaloni
- Department of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
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Gonzalez-Ochoa E, Alqaisi HA, Bhat G, Jivraj N, Lheureux S. Inoperable Bowel Obstruction in Ovarian Cancer: Prevalence, Impact and Management Challenges. Int J Womens Health 2022; 14:1849-1862. [PMID: 36597479 PMCID: PMC9805709 DOI: 10.2147/ijwh.s366680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/17/2022] [Indexed: 12/29/2022] Open
Abstract
Malignant bowel obstruction (MBO) is one of the most severe complications in patients with advanced ovarian cancer, with an estimated incidence up to 50%. Its presence is related to poor prognosis and a life expectancy measured in weeks for inoperable cases. Symptoms are usually difficult to manage and often require hospitalization, which carries a high burden on patients, caregivers and the healthcare system. Management is complex and requires a multidisciplinary approach to improve clinical outcomes. Patients with inoperable MBO are treated medically with analgesics, antiemetics, steroids and antisecretory agents. Parenteral nutrition and gut decompression with nasogastric tube, venting gastrostomy or stenting may be used as supportive therapy. Treatment decision-making is challenging and often based on clinical expertise and local policies, with lack of high-quality evidence to optimally standardize management. The present review summarizes current literature on inoperable bowel obstruction in ovarian cancer, focusing on epidemiology, prognostic factors, clinical outcomes, medical management, multidisciplinary interventions and quality of life.
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Affiliation(s)
- Eduardo Gonzalez-Ochoa
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Husam A Alqaisi
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Gita Bhat
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nazlin Jivraj
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Stephanie Lheureux
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada,Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Correspondence: Stephanie Lheureux, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada, Tel +1 416-946-2818, Email
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3
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Kim GH, Shin JH, Zeng CH, Park JH. Recent Updates in Gastrointestinal Stent Placement from the Esophagus to the Colon: A Radiological Perspective. Cardiovasc Intervent Radiol 2022; 45:425-437. [PMID: 35166883 DOI: 10.1007/s00270-022-03067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/24/2022] [Indexed: 11/02/2022]
Abstract
Fluoroscopic-guided stent placement has become an advantageous treatment option for diverse gastrointestinal disorders. In addition to palliative stent placement in patients with inoperable cancers, stenting has gradually expanded to other conditions, including as a bridge to surgery, as well as in patients' benign lesions and anastomotic strictures or leaks. This narrative review describes the indications, efficacy and safety of stent placement from the esophagus to the colon, including current recommendations, recent updates, and novel stents.
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Affiliation(s)
- Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea.
| | - Chu Hui Zeng
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea
| | - Jung Hoon Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea
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Short-Term Outcomes of Colorectal Stenting Using a Low Axial Force Self-Expandable Metal Stent for Malignant Colorectal Obstruction: A Japanese Multicenter Prospective Study. J Clin Med 2021; 10:jcm10214936. [PMID: 34768456 PMCID: PMC8585095 DOI: 10.3390/jcm10214936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/15/2022] Open
Abstract
(1) Background: Endoscopic colorectal stenting with high technical success and safety is essential in discussing the oncological outcomes for the management of malignant colorectal obstruction. Mechanical properties of self-expandable metal stents are usually considered to affect clinical outcomes. (2) Methods: A multicenter, prospective study was conducted in Japan. A self-expandable metal stent with low axial force was inserted endoscopically. The primary endpoint was clinical success, defined as the resolution of symptoms and radiological findings within 24 h. Secondary endpoints were technical success and adverse events. Short-term outcomes of 7 days were evaluated in this study. (3) Results: Two hundred and five consecutive patients were enrolled. Three patients were excluded, and the remaining 202 patients were evaluated. The technical and clinical success rates were 97.5% and 96.0%, respectively. Major stent-related adverse events included stent migration (1.0%), insufficient stent expansion (0.5%), and stent occlusion (0.5%). No colonic perforation was observed. There were two fatal cases (1%) which were not related to stent placement. (4) Conclusions: The placement of self-expandable metal stents with low axial force is safe with no perforation and showed high technical and clinical success rates in short-term outcomes for the management of malignant colorectal obstruction.
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Abstract
Malignant bowel obstruction is a challenging clinical problem encountered in patients with advanced abdominal and pelvic malignancies. Although medical therapies form the foundation of management, some patients may be suitable candidates for surgical and procedural interventions. The literature is composed primarily of retrospective single-institution experiences and the results of prospective trials are pending. Given the high symptom burden and limited life expectancy of these patients, management may be best informed by multidisciplinary teams with relevant expertise.
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Affiliation(s)
- Caitlin T Yeo
- Division of Surgical Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29 St NW, Calgary, Alberta T2N 4N2, Canada
| | - Shaila J Merchant
- Division of General Surgery and Surgical Oncology, Queen's University, Burr 2, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
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6
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Sano T, Nozawa Y, Iwanaga A, Azumi M, Imai M, Ishikawa T, Honma T, Yoshida T. Comparison of the efficacy of self-expandable metallic stents in colorectal obstructions caused by extracolonic malignancy and colorectal cancer. Mol Clin Oncol 2021; 15:170. [PMID: 34295470 PMCID: PMC8273924 DOI: 10.3892/mco.2021.2332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/01/2021] [Indexed: 11/05/2022] Open
Abstract
The current study aimed to compare the safety and effectiveness of self-expandable metallic stent placement among patients with extracolonic malignancy and those with colorectal cancer. Patient information, technical and clinical success rates and complication rates were compared between patients with colorectal cancer and extracolonic malignancy. The Kaplan-Meier method was used to compare the time elapsed before the onset of complications. Risk factors for re-obstruction in patients with self-expandable metallic stents were evaluated by multivariate analysis. A total of 68 patients who underwent self-expandable metallic stent placement at Saiseikai Niigata Hospital between January 2012 and September 2019 were included. The clinical success rate was significantly different between the colorectal cancer (96.6%) and extracolonic malignancy (66.7%) groups (P=0.01). The incidence of complications was significantly higher in the extracolonic malignancy group (66.7%) than in the colorectal cancer group (25.4%; P=0.02). Additionally, the time elapsed before the onset of complications was shorter in the extracolonic malignancy group than in the colorectal cancer group (P=0.0008). Risk factors for re-obstruction were higher in the extracolonic malignancy group [odds ratio, 7.76 (1.02-57.2)] than in the palliative stent placement group [odds ratio, 5.45 (1.01-29.5); P=0.04]. In extracolonic malignancy, self-expandable metallic stent placement was associated with lower clinical success rates and increased risk of complications. The time elapsed before the onset of complications was short, and extracolonic malignancy was a risk factor for re-obstruction, suggesting that the placement of self-expandable metallic stents for malignant colorectal obstruction in extracolonic malignancy is not optimal.
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Affiliation(s)
- Tomoe Sano
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata 950-1104, Japan
| | - Yujiro Nozawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata 950-1104, Japan
| | - Akito Iwanaga
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata 950-1104, Japan
| | - Motoi Azumi
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata 950-1104, Japan
| | - Michitaka Imai
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata 950-1104, Japan
| | - Toru Ishikawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata 950-1104, Japan
| | - Terasu Honma
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata 950-1104, Japan
| | - Toshiaki Yoshida
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata 950-1104, Japan
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Kwaan MR, Ren Y, Wu Y, Xirasagar S. Colonic Stent Use by Indication and Patient Outcomes: A Nationwide Inpatient Sample Study. J Surg Res 2021; 265:168-179. [PMID: 33940240 DOI: 10.1016/j.jss.2021.03.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/14/2021] [Accepted: 03/22/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Colonic stent placement can avoid urgent surgery for large bowel obstruction in selected patients. Population-wide stent utilization patterns and outcomes are unknown. MATERIALS AND METHODS Using retrospective, population-based, Nationwide Inpatient Sample data, we studied patients with colonic stents discharged during 2010-2015. The primary outcome was ostomy creation during the same hospitalization. Other outcomes were perforation or peritonitis, and in-hospital death. Associations of outcomes with stent indication were investigated, adjusting for patient-, admission-, and hospital characteristics. We estimated annual population-wide stent use volumes. RESULTS Of 4257 patients with stent placement (52% male, mean age 64.6 years), 9.9% had non-metastatic colon cancer, 12.9% metastatic colon cancer, 37.8% extracolonic malignancy (ECM), and 39.3% had benign obstruction. In 8.1% of patients, ostomy creation surgery was performed. Perforation or peritonitis occurred in 16.7%, and in-hospital death in 4.5%. Relative to ECM, ostomy creation was several-fold more likely among nonmetastatic colon cancer (adjusted odds ratio (OR) 3.4; 95%CI, 2.1-5.5), metastatic colon cancer (adjusted OR 2.5; 95%CI, 1.7-3.7), and benign obstruction patients (adjusted OR 3.1; 95%CI, 2.1-4.7). Benign obstruction was associated with high risk of perforation/peritonitis (adjusted OR 3.1 relative to non-metastatic CC (95%CI, 2.1-4.5)). Perforation/peritonitis was highly associated with inpatient death (adjusted OR 6.8 (95%CI, 4.9-9.5)). Annually, about 3,580 patients underwent stent placement, with benign obstruction showing an increasing trend (P=0.0002). CONCLUSIONS Over 75% of stent placements were done for patients with benign disease and ECM obstruction. Subsequent ostomy creation during the hospitalization was least likely among ECM patients. Rates of perforation/peritonitis in benign obstructions were concerningly high. (22.2%).
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Affiliation(s)
- Mary R Kwaan
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Yang Ren
- University of South Carolina, Department of Computer Science and Engineering, Columbia, SC
| | - Yuqi Wu
- University of South Carolina, Department of Health Services Policy and Management, Columbia, SC
| | - Sudha Xirasagar
- University of South Carolina, Department of Health Services Policy and Management, Columbia, SC
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8
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9
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Self-expandable metal stent (SEMS) placement or emergency surgery as palliative treatment for obstructive colorectal cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 155:103110. [DOI: 10.1016/j.critrevonc.2020.103110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
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Ahn JS, Hong SN, Chang DK, Kim YH, Kim ER. Efficacy of uncovered self-expandable metallic stent for colorectal obstruction by extracolonic malignancy. World J Gastrointest Oncol 2020; 12:1005-1013. [PMID: 33005294 PMCID: PMC7510003 DOI: 10.4251/wjgo.v12.i9.1005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/05/2020] [Accepted: 08/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Self-expandable metallic stent (SEMS) is widely used for malignant colorectal obstruction. Recently, SEMS has been used for palliative option for colorectal obstruction caused by extracolonic malignancy (ECM).
AIM To evaluate the efficacy of SEMS for colorectal obstruction caused by ECM, and to identify the factors associated with stent occlusion.
METHODS Seventy-two patients who were treated with uncovered SEMS insertion for malignant colorectal obstructions caused by colorectal metastasis or peritoneal seeding of ECM at Samsung Medical Center between April 2012 to March 2016 were enrolled. We analyzed technical and clinical outcomes of stent insertion, the factors associated with stent occlusion and long term outcomes after stent insertion.
RESULTS Technical success rate was determined as 90.3% with a clinical success rate of 87.7%. Stent occlusion developed in 28.1%, with a median duration of 51 d. Further, 81.3% with stent occlusion could be treated with secondary stent insertion. Clinical failure was observed to be related to the male sex (P = 0.020) and right colon obstruction (P = 0.017). Stent length ≤ 10 cm was found to be associated with stent occlusion (P = 0.003). Median survival time after stent insertion was 4.7 mo and 40.4% were able to receive their oncological treatments after stent insertion without surgery.
CONCLUSION Uncovered SEMS is effective for the treatment of colorectal obstruction caused by ECM, considering life expectancy of patients with ECM.
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Affiliation(s)
- Joon Seong Ahn
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Sung Noh Hong
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Dong Kyung Chang
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Young-Ho Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Eun-Ran Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
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Weston BR, Patel JM, Pande M, Lum PJ, Ross WA, Raju GS, Lynch PM, Coronel E, Ge PS, Lee JH. Efficacy of uncovered colonic stents for extrinsic versus intrinsic malignant large bowel obstruction. Surg Endosc 2020; 35:4511-4519. [PMID: 32909212 DOI: 10.1007/s00464-020-07965-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 08/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Previous studies evaluating self-expandable metal stents (SEMS) for management of malignant extrinsic colon obstruction have yielded conflicting results. We evaluated the efficacy of uncovered SEMS for extrinsic colon malignancy (ECM) versus intrinsic colon malignancy (ICM). METHODS Retrospective review of all patients referred for colonic SEMS at a tertiary cancer center between 2007 and 2018 was performed. Primary outcome measures were technical success, clinical success, intervention rate, and overall survival. RESULTS 138 patients with ECM and 119 patients with ICM underwent attempted stent placement. The rectum and/or sigmoid colon was the most common stricture site. Technical success was lower in the ECM group [86% vs 96% (p = .009)]. Clinical success was lower in the ECM group both at 7 days [82% vs 95% (p = .004)] and at 90 days [60% vs 86% (p < .001)]. Subsequent intervention was required more frequently [44% vs 35%; p = .23] and earlier [median 9 vs 132 days; p < .001] in the ECM group. Median overall survival in the ECM group was 92 vs 167 days. Among predictive variables analyzed, the ECM group had a higher frequency of peritoneal metastasis (87% vs 32%; p < .001), multifocal strictures with requirement for multiple stents (20% vs 6%; p = .002), sharp angulated strictures (39% vs 25%; p = .04) , and radiation therapy (21% vs 10%; p = .02). CONCLUSIONS Colonic SEMS for ECM is associated with lower technical and clinical success with earlier intervention rates compared with ICM. Our findings can be used to better inform patients and referring providers as well as guide new stent design to enhance efficacy in this population.
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Affiliation(s)
- Brian R Weston
- Department Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX, 77030-4009, USA.
| | - Jigar M Patel
- Department Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX, 77030-4009, USA
| | - Mala Pande
- Department Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX, 77030-4009, USA
| | - Phillip J Lum
- Department Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX, 77030-4009, USA
| | - William A Ross
- Department Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX, 77030-4009, USA
| | - Gottumukkala S Raju
- Department Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX, 77030-4009, USA
| | - Patrick M Lynch
- Department Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX, 77030-4009, USA
| | - Emmanuel Coronel
- Department Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX, 77030-4009, USA
| | - Phillip S Ge
- Department Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX, 77030-4009, USA
| | - Jeffrey H Lee
- Department Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX, 77030-4009, USA
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Stent Placement for Palliative Treatment of Malignant Colorectal Obstruction: Extracolonic Malignancy Versus Primary Colorectal Cancer. AJR Am J Roentgenol 2020; 215:248-253. [PMID: 32319795 DOI: 10.2214/ajr.19.22247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE. The purpose of this study is to compare the clinical outcomes of stent placement for the palliative treatment of colorectal obstruction in patients with extracolonic malignancy (ECM) versus those with primary colorectal cancer (CRC) and to identify the risk factors for stent failure. MATERIALS AND METHODS. Between January 2005 and December 2017, a total of 85 patients underwent stent placement for the palliative treatment of inoperable malignant colorectal obstructions caused by ECM (n = 56) or CRC (n = 29). Technical and clinical success, reintervention rates, and stent patency were compared between the two groups. Predictive factors associated with stent failure were identified. RESULTS. Stent placement was technically successful in 54 patients with ECM (96.4%) and 27 patients with CRC (93.1%) (p = 0.60). The proportion of patients with ECM who required reintervention was greater than that of patients with CRC (20.4% vs 3.7%, respectively; p = 0.04); however, they had a marginally lower clinical success rate (88.9% vs 100.0%, respectively; p = 0.07). The 6- and 12-month stent patency rates were 64.2% and 22.0%, respectively, in patients with ECM and 68.4% and 31.3%, respectively, in patients with CRC (p = 0.89). Long obstructions (hazard ratio, 1.40) and multiple obstructions (hazard ratio, 4.03) were independent factors associated with stent failure. CONCLUSION. Stent placement for the palliative treatment of colorectal obstruction is less effective and more frequently requires reintervention in patients with ECM than in patients with CRC. Long obstructions and multiple obstructions were associated with stent failure.
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Abstract
Acute malignant large bowel obstruction presents as one of the few emergencies of colorectal cancer (CRC). Management of this condition can either be by (I) upfront surgery or (II) the use of self-expanding metallic stent (SEMS) as a bridge to elective surgery. For patients with metastasis, the use of SEMS is reported to enable earlier commencement of chemotherapy. Although the use of SEMS in patients with acute malignant large bowel obstruction looks promising, it is plagued by its own set of complications and divided opinion over its long-term outcomes. Conflicting data are present, and definitive indication requires further evaluation and debate. This article will describe the typical presentation of patients with acute malignant large bowel obstruction. An introduction to the SEMS insertion procedural steps will be undertaken. Following which the article aims to review the safety profile of SEMS and the short- and long-term outcomes of SEMS in both the curative and palliative setting.
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Affiliation(s)
- Tian-Zhi Lim
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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14
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Ormando VM, Palma R, Fugazza A, Repici A. Colonic stents for malignant bowel obstruction: current status and future prospects. Expert Rev Med Devices 2019; 16:1053-1061. [PMID: 31778081 DOI: 10.1080/17434440.2019.1697229] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Although more than two decades are already passed from the first description of this technique, the debate remains open on the role of self-expanding metal stents (SEMS) placement in the management of malignant bowel obstruction (MBO). According to most recent data, SEMS placement is considered a safe and effective alternative treatment as a bridge to surgery(BTS). In addition, stent placement should be considered as primary option for palliative treatment of obstructing cancer.Areas covered: Current status, indication, technique, oncological outcomes, advantages, and risks of SEMS placement in MBO were reviewed.Expert commentary: The placement of colonic SEMS for palliation and for BTS in patients with MBO has been increasingly reported and it seems to have several advantages over emergency surgery. Substantial concerns of tumor seeding following SEMS placement, especially in case of perforation, have been raised in numerous studies. Actually, no significant differences are reported in oncologic long-term survival between patients undergoing stent placement as a BTS and those undergoing emergency surgery. Considering all the mentioned factors, indication for colorectal stenting should be evaluated only in highly specialized centers, in the context of multidisciplinary approach where risks and benefits of stenting are carefully weighed, especially in the BTS setting.
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Affiliation(s)
- Vittorio Maria Ormando
- Division of Gastroenterology, Humanitas Research Hospital, Digestive Endoscopy Unit, Rozzano, Italy
| | - Rossella Palma
- Division of Gastroenterology, Humanitas Research Hospital, Digestive Endoscopy Unit, Rozzano, Italy
| | - Alessandro Fugazza
- Division of Gastroenterology, Humanitas Research Hospital, Digestive Endoscopy Unit, Rozzano, Italy
| | - Alessandro Repici
- Division of Gastroenterology, Humanitas Research Hospital, Digestive Endoscopy Unit, Rozzano, Italy
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15
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Mashar M, Mashar R, Hajibandeh S. Uncovered versus covered stent in management of large bowel obstruction due to colorectal malignancy: a systematic review and meta-analysis. Int J Colorectal Dis 2019; 34:773-785. [PMID: 30903271 DOI: 10.1007/s00384-019-03277-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare outcomes of uncovered stent and covered stent in management of large bowel obstruction secondary to colorectal malignancy. METHODS We conducted a search of electronic databases identifying studies comparing outcomes of uncovered and covered stents in management of large bowel obstruction secondary to colorectal malignancy. The Cochrane risk-of-bias tool and the Newcastle-Ottawa scale were used to assess the included studies. Random or fixed effects modelling were applied as appropriate to calculate pooled outcome data. RESULTS One randomised controlled trial (RCT) and nine observational studies, enrolling 753 patients, were identified. Uncovered stent was associated with lower risks of complications (RR 0.57 95% CI 0.44-0.74, P < 0.0001), tumour overgrowth (RR 0.29 95% CI 0.09-0.93, P = 0.04), and stent migration (RR 0.29 95% CI 0.17-0.48, P < 0.00001); longer duration of patency (MD 18.47 95% CI 10.46-26.48, P < 0.00001); lower need for stent reinsertion (RR 0.38 95% CI 0.17-0.86, P = 0.02); and higher risk of tumour ingrowth (RR 4.53 95% CI 1.92-10.69, P = 0.0008). Rates of technical success (RR 1.02 95% CI 0.99-1.04, P = 0.21), clinical success (RR 1.03 95% CI 0.98-1.08, P = 0.32), perforation (RD 0.01 95% CI - 0.03-0.02, P = 0.65), bleeding (RD 0.00 95% CI - 0.03-0.03, P = 0.98), stool impaction (RR 0.56 95% CI 0.12-2.04, P = 0.38) and stent obstruction (RR 2.23 95% CI 0.94-5.34, P = 0.97) were similar. CONCLUSIONS Our results suggest that uncovered stents are superior as indicated by fewer complications, lower rates of stent migration, longer duration of patency and a reduced need for stent reinsertion. The best available evidence is mainly derived from non-randomised studies; there is a need for more RCTs.
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Affiliation(s)
- Meghavi Mashar
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Ruchir Mashar
- Department of General Surgery, Hereford County Hospital, Hereford, HR1 2BN, UK
| | - Shahab Hajibandeh
- Department of General Surgery, North Manchester General Hospital, Manchester, M8 5RB, UK
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Ribeiro IB, de Moura DTH, Thompson CC, de Moura EGH. Acute abdominal obstruction: Colon stent or emergency surgery? An evidence-based review. World J Gastrointest Endosc 2019; 11:193-208. [PMID: 30918585 PMCID: PMC6425283 DOI: 10.4253/wjge.v11.i3.193] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 01/29/2019] [Accepted: 02/13/2019] [Indexed: 02/06/2023] Open
Abstract
According to the American Cancer Society and Colorectal Cancer Statistics 2017, colorectal cancer (CRC) is one of the most common malignancies in the United States and the second leading cause of cancer death in the world in 2018. Previous studies demonstrated that 8%-29% of patients with primary CRC present malignant colonic obstruction (MCO). In the past, emergency surgery has been the primary treatment for MCO, although morbidity and surgical mortality rates are higher in these settings than in elective procedures. In the 1990s, self-expanding metal stents appeared and was a watershed in the treatment of patients in gastrointestinal surgical emergencies. The studies led to high expectations because the use of stents could prevent surgical intervention, such as colostomy, leading to lower morbidity and mortality, possibly resulting in higher quality of life. This review was designed to provide present evidence of the indication, technique, outcomes, benefits, and risks of these treatments in acute MCO through the analysis of previously published studies and current guidelines.
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Affiliation(s)
- Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo 05403-000, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo 05403-000, Brazil
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
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Faraz SB, Salem SB, Schattner M, Mendelsohn R, Markowitz A, Ludwig E, Zheng J, Gerdes H, Shah P. Predictors of clinical outcome of colonic stents in patients with malignant large-bowel obstruction because of extracolonic malignancy. Gastrointest Endosc 2018; 87:1310-1317. [PMID: 29307474 PMCID: PMC8439169 DOI: 10.1016/j.gie.2017.12.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Colonic stent placement in patients with large-bowel obstruction (LBO) secondary to extracolonic malignancy (ECM) has been evaluated in small series with heterogeneous results. Our aim is to better characterize the technical and clinical success of colonic stent placement and to identify factors that affect this success in ECM patients. METHODS All patients at a single high-volume center who presented for colonic stent placement for LBO because of ECM between 2001 and 2012 were retrospectively identified. The outcomes of interest were technical success, clinical success, stent occlusion rate, and overall survival. RESULTS A total of 187 patients were identified. Mean age was 61.9 years (range, 23-89), and 150 (80.2%) were women. The most common malignancy type was urogynecologic (n = 104) and most common location sigmoid colon (n = 128). Overall, 142 patients (75.9%) achieved technical success and 102 patients (54.5%) clinical success. Radiographic presence of peritoneal carcinomatosis (P < .001) and multifocal disease (P < .001) were associated with both decreased technical and clinical success. Procedure-related adverse events were seen in 12 patients (6.4%). In patients with clinical success, the incidence of stent occlusion at 3 months was 14.7% (95% confidence interval, 7.8%-21.6%) and was higher in patients with prior radiation therapy (P = .011). The median overall survival for all patients from time of attempted stent placement was 3.3 months (95% confidence interval, 3.0-4.1). CONCLUSIONS This study represents the largest retrospective series of colonic stent placement for LBO in ECM patients in the literature. Our technical success rate of 75.9%, clinical success rate of 54.5%, and 3-month stent occlusion rate of 14.7% suggest that stent placement is a viable palliative option for patients with advanced disease because of ECM. Patients with peritoneal carcinomatosis and multifocal disease have reduced technical and clinical success. However, these factors should not dissuade an attempt at stent placement, if risk-to-benefit analysis is favorable.
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Affiliation(s)
- Shahdabul B.S. Faraz
- Weill Cornell Medical College, New York, NY, USA,Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | - Emmy Ludwig
- Weill Cornell Medical College, New York, NY, USA
| | | | - Hans Gerdes
- Weill Cornell Medical College, New York, NY, USA
| | - Pari Shah
- Weill Cornell Medical College, New York, NY, USA
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Chen Q, Yu Q, Yu JJ, Liu M, Xie HP, Cheng B, Guao QZ, Liao GQ, Qin H. Observational study of colonoscopy techniques used for acute colorectal obstruction: A single-center experience. Mol Clin Oncol 2017; 6:355-361. [PMID: 28451412 PMCID: PMC5403636 DOI: 10.3892/mco.2017.1133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/09/2016] [Indexed: 12/16/2022] Open
Abstract
The prevalence of acute colorectal obstruction at the hospital setting is high. There is need for improvement in the quality of colonoscopy for relieving obstruction. A retrospective, uncontrolled, open-label study was conducted, with the aim of documenting the causes of acute colorectal obstruction and the quality of colonoscopy practice in managing obstruction at a university hospital in China. A total of 61 adult patients with acute colorectal obstruction treated with urgent colonoscopy between February, 2011 and January, 2016 were identified at the Endoscopic Unit of Tongji Hospital (Wuhan, China). The technique success rate was the primary outcome. The etiology was mainly related to malignant diseases, including colorectal cancer in 53 patients (86.9%) and advanced peritoneal serous carcinoma leading to extrinsic colonic compression in 1 patient (1.6%). Benign causes of obstruction included foreign bodies in 3 patients (4.9%) and fecal impaction in 2 patients (3.3%); furthermore, anastomotic strictures were found in 2 patients (3.3%). The technique success rate was 98.4% (60/61). All colorectal cancer patients who underwent urgent colonoscopy were admitted to the Department of Surgery for placement of a self-expanding metallic stent; 1 patient who had an extracolonic malignancy underwent placement of a transanal colonoscopic decompression tube as palliative therapy and 2 patients with anastomotic strictures underwent endoscopic balloon dilation. Furthermore, colonoscopy was used for extracting the foreign body, as well as removing fecal stones in all the patients. In conclusion, urgent colonoscopy as a minimal invasive approach is associated with certain advantages for diagnosing and managing acute colorectal obstruction. Furthermore, experienced operators achieved a better outcome when managing colorectal obstruction.
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Affiliation(s)
- Qian Chen
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Qin Yu
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Jing-Jing Yu
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Mei Liu
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Hua-Ping Xie
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Bin Cheng
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Qiao-Zhen Guao
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Guang-Quan Liao
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
| | - Hua Qin
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei 430030, P.R. China
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Predictors of outcome for endoscopic colorectal stenting: a decade experience. Int J Colorectal Dis 2017; 32:375-382. [PMID: 27817034 DOI: 10.1007/s00384-016-2696-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Endoscopic stenting is used with increasing frequency to treat colorectal conditions. Little is known about what influences outcome. This study aimed to determine the impact of various factors on the short- and long-term results of colorectal stenting. METHODS A retrospective review was conducted of all endoscopic stenting procedures performed by a colorectal surgeon at a tertiary referral institution between 2003 and 2013. Main outcome measures included technical success, clinical success, complications, and predictors of outcome. RESULTS Of the stent procedures, 183 were performed in 165 patients. The majority of patients (90 %) presented with a malignant obstruction (intrinsic colonic vs. extrinsic non-colonic). Carcinomatosis was present in 22 % of patients with malignancy, and it was associated with lower technical success compared to non-carcinomatosis (adjusted odds ratio [AOR] 0.2 [95 % confidence interval (CI) 0.1-0.8]; p = 0.021). Colonic malignancy was associated with higher clinical success compared to non-colonic malignancy (AOR 3.8 [95 % CI 1.4-10.3]; p = 0.009). Carcinomatosis increased the risk of complications compared to non-carcinomatosis (AOR 3.2 [95 % CI 1.0-10.0]; p = 0.049). The risk of complication was higher when a stent was deployed in the rectum compared to the colon (AOR 4.1 [95 % CI 1.5-11.7]; p = 0.008). The use of a covered stent was associated with higher complication rate compared to a non-covered stent (AOR 13.6 [95 % CI 2.6-71.2]; p = 0.002). Balloon dilation was associated with an increased risk of complications (AOR 4.6 [95 % CI 1.3-16.2]; p = 0.017). CONCLUSIONS Carcinomatosis was associated with lower technical success rate. Clinical success was higher in patients with a primary colonic malignancy. The use of a covered stent, balloon dilation of stricture, lesions in the rectum, and carcinomatosis were associated with higher risk for complications.
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21
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Radiologic Placement of Uncovered Stents for the Treatment of Malignant Colonic Obstruction Proximal to the Descending Colon. Cardiovasc Intervent Radiol 2016; 40:99-105. [PMID: 27671155 DOI: 10.1007/s00270-016-1474-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/19/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the safety, feasibility, and patency rates of radiologic placement of uncovered stents for the treatment of malignant colonic obstruction proximal to the descending colon. MATERIALS AND METHODS This was a retrospective, single-center study. From May 2003 to March 2015, 53 image-guided placements of uncovered stents (44 initial placements, 9 secondary placements) were attempted in 44 patients (male:female = 23:21; mean age, 71.8 years). The technical and clinical success, complication rates, and patency rates of the stents were also evaluated. Technical success was defined as the successful deployment of the stent under fluoroscopic guidance alone and clinical success was defined as the relief of obstructive symptoms or signs within 48 h of stent deployment. RESULTS In total, 12 (27.3 %) patients underwent preoperative decompression, while 32 (72.7 %) underwent decompression with palliative intent. The technical success rate was 93.2 % (41/44) for initial placement and 88.9 % (8/9) for secondary placement. Secondary stent placement in the palliative group was required in nine patients after successful initial stent placement due to stent obstruction from tumor ingrowth (n = 7) and stent migration (n = 2). The symptoms of obstruction were relieved in all successful cases (100 %). In the palliative group, the patency rates were 94.4 % at 1 month, 84.0 % at 3 months, 64.8 % at 6 months, and 48.6 % at 12 months. CONCLUSIONS The radiologic placement of uncovered stents for the treatment of malignant obstruction proximal to the descending colon is feasible and safe, and provides acceptable clinical results.
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22
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Takahashi H, Okabayashi K, Tsuruta M, Hasegawa H, Yahagi M, Kitagawa Y. Self-Expanding Metallic Stents Versus Surgical Intervention as Palliative Therapy for Obstructive Colorectal Cancer: A Meta-analysis. World J Surg 2016; 39:2037-44. [PMID: 25894403 DOI: 10.1007/s00268-015-3068-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although self-expanding metallic stents (SEMS) are useful tools for relieving large bowel obstructions in patients with colorectal cancer (CRC), their efficacy in a palliative setting has not been validated. This meta-analysis aimed to evaluate the feasibility of SEMS as a palliation for unresectable CRC patients with bowel obstructions and to determine their contribution to the prognosis of CRC, compared with surgical intervention. METHODS We conducted a literature search of the PubMed and Cochrane Library databases. We selected all controlled trials that compared SEMS with surgical interventions as palliative treatments in unresectable obstructive CRC patients. The primary outcome was early complications, and the secondary outcomes were mortality, other morbidities, and long-term survival rates. RESULTS Ten studies met our inclusion criteria. SEMS significantly reduced the risk of early complications (odds ratio [OR] 0.34; 95% confidence interval [CI] 0.20-0.58%; P<0.01), mortality (OR 0.31; 95% CI 0.15%-0.64%; P<0.01), and stoma creation (OR 0.19; 95% CI 0.12-0.28%; P<0.01). Although SEMS placement was significantly associated with a higher risk of perforation of the large bowel (OR 5.25 95% CI 2.00-13.78%; P<0.01) and late complications (OR 1.94; 95% CI 0.90-4.19%; P=0.03), it also contributed significantly to better long-term survival (hazard ratio 0.46; 95% CI 0.31-0.68%; P<0.01). CONCLUSIONS Compared with surgical intervention, SEMS could provide feasible palliation for patients with bowel obstructions and unresectable CRC, because of their acceptable morbidity rates and better patient prognoses.
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Affiliation(s)
- Hidena Takahashi
- Department of Surgery, Keio University School of Medicine, 35 Shinanotmachi, Shinjuku-ku, Tokyo, Japan,
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23
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Kim EJ, Kim YJ. Stents for colorectal obstruction: Past, present, and future. World J Gastroenterol 2016; 22:842-852. [PMID: 26811630 PMCID: PMC4716082 DOI: 10.3748/wjg.v22.i2.842] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/22/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023] Open
Abstract
Since the development of uncovered self-expanding metal stents (SEMS) in the 1990s, endoscopic stents have evolved dramatically. Application of new materials and new designs has expanded the indications for enteral SEMS. At present, enteral stents are considered the first-line modality for palliative care, and numerous types of enteral stents are under development for extended clinical usage, beyond a merely palliative purpose. Herein, we will discuss the current status and the future development of lower enteral stents.
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24
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Malgras B, Lo Dico R, Pautrat K, Dohan A, Boudiaf M, Pocard M, Soyer P. Gastrointestinal stenting: Current status and imaging features. Diagn Interv Imaging 2015; 96:593-606. [PMID: 25953525 DOI: 10.1016/j.diii.2015.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 12/13/2022]
Abstract
The use of stents in the gastrointestinal tract has been subjected to major changes. Initially, the use of stents was restricted to malignant strictures in patients with metastatic disease. But thanks to reduction of the morbidity and mortality rates, they are now used with curative intention and in patients with benign diseases after careful selection. However, for patients presenting with colon obstruction due to an advanced colon carcinoma, the mortality and morbidity are still high. The purpose of this review is to provide an overview of indications, techniques and further developments of the stents in the gastrointestinal tract and to highlight the predominant role of multidetector row computed tomography (MDCT) in the detection of potential complications.
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Affiliation(s)
- B Malgras
- Department of Surgical Oncology, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
| | - R Lo Dico
- Department of Surgical Oncology, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - K Pautrat
- Department of Surgical Oncology, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - A Dohan
- Department of Abdominal and Interventional Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Sorbonne Paris Cité, université Diderot - Paris 7, 10, avenue de Verdun, 75010 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Boudiaf
- Department of Abdominal and Interventional Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - M Pocard
- Department of Surgical Oncology, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Sorbonne Paris Cité, université Diderot - Paris 7, 10, avenue de Verdun, 75010 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - P Soyer
- Department of Abdominal and Interventional Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Sorbonne Paris Cité, université Diderot - Paris 7, 10, avenue de Verdun, 75010 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
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25
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Yoshida S, Isayama H, Koike K. Palliative self-expandable metallic stent placement for colorectal obstruction caused by an extracolonic malignancy. GASTROINTESTINAL INTERVENTION 2014. [DOI: 10.1016/j.gii.2014.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Hong SP, Kim TI. Colorectal stenting: An advanced approach to malignant colorectal obstruction. World J Gastroenterol 2014; 20:16020-16028. [PMID: 25473154 PMCID: PMC4239488 DOI: 10.3748/wjg.v20.i43.16020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 06/12/2014] [Accepted: 07/11/2014] [Indexed: 02/06/2023] Open
Abstract
Some colorectal cancer (CRC) patients present symptoms of bowel obstruction, which is considered a surgical emergency. Because of poor medical condition and high incidence of post-surgical complications, there has been increasing use of self-expanding metal stents (SEMS) for the purpose of palliation or as a bridge to surgery with some benefits, including shorter hospital stays, lower rates of adverse events, and one-stage surgery. However, with increasing survival of CRC patients, there have been controversial data on clinical outcomes and complications, compared between SEMS use and surgery for treatment of malignant bowel obstruction. We review recent clinical data on clinical outcomes of SEMS use compared to surgery, including complications.
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van Hooft JE, van Halsema EE, Vanbiervliet G, Beets-Tan RGH, DeWitt JM, Donnellan F, Dumonceau JM, Glynne-Jones RGT, Hassan C, Jiménez-Perez J, Meisner S, Muthusamy VR, Parker MC, Regimbeau JM, Sabbagh C, Sagar J, Tanis PJ, Vandervoort J, Webster GJ, Manes G, Barthet MA, Repici A. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Gastrointest Endosc 2014; 80:747-61.e1-75. [PMID: 25436393 DOI: 10.1016/j.gie.2014.09.018] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 08/25/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Emo E van Halsema
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - John M DeWitt
- Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
| | - Fergal Donnellan
- UBC Division of Gastroenterology, Vancouver General Hospital, Vancouver, Canada
| | | | | | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Javier Jiménez-Perez
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Søren Meisner
- Endoscopy Unit, Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark
| | - V Raman Muthusamy
- Division of Gastroenterology and Hepatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | | | - Jean-Marc Regimbeau
- Department of Digestive and Oncological Surgery, University Hospital of Amiens, France
| | - Charles Sabbagh
- Department of Digestive and Oncological Surgery, University Hospital of Amiens, France
| | - Jayesh Sagar
- Department of Colorectal Surgery, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Pieter J Tanis
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Jo Vandervoort
- Department of Gastroenterology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - George J Webster
- Department of Gastroenterology, University College Hospital, London, United Kingdom
| | - Gianpiero Manes
- Department of Gastroenterology and Endoscopy, Guido Salvini Hospital, Garbagnate Milanese/Rho, Milan, Italy
| | - Marc A Barthet
- Department of Gastroenterology, Hôpital Nord, Aix Marseille Université, Marseille, France
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Moon SJ, Kim SW, Lee BI, Lim CH, Kim JS, Soo J, Park JM, Lee IS, Choi MG, Choi KY. Palliative stent for malignant colonic obstruction by extracolonic malignancy: a comparison with colorectal cancer. Dig Dis Sci 2014; 59:1891-7. [PMID: 24077942 DOI: 10.1007/s10620-013-2876-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 09/03/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Palliative self-expandable metal stent placement for colonic obstruction arising from an extracolonic malignancy might be as useful as that for colorectal cancer, but data are limited. The purposes of this study were to investigate success and complications of stent placement in patients with extracolonic malignancy and to compare long-term clinical outcomes for an extracolonic malignancy group with those for a colorectal cancer group. PATIENTS AND METHODS We reviewed short-term and long-term outcomes for patients treated with palliative stents for colonic obstruction by extracolonic malignancy (n = 44) or unresectable colorectal cancer (n = 53) from January 2006 to March 2011. RESULTS Neither the technical success (93.2 vs. 98.1 %, respectively; P = 0.326) nor clinical success (77.3 vs. 84.9 %, respectively; P = 0.433) of stent placement differed significantly in the two groups. Complications as a result of stent placement also differed only slightly in the two groups (perforation: 4.8 % (two cases) vs. 0 %, respectively; migration: 4.8 vs. 5.8 %, respectively, P = 0.343). With regard to long-term outcomes, although stent patency was shorter in the extracolonic malignancy group (P = 0.015), because overall survival in this group was also shorter (P = 0.018), it was sufficient for palliative purposes. CONCLUSIONS Palliative stent placement was equally effective and safe for treatment of colonic obstruction arising from either extracolonic malignancy or unresectable colorectal cancer. Even in cases of colonic obstruction arising from extracolonic malignancy, stent placement should be considered as primary palliative therapy.
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van Halsema EE, van Hooft JE, Small AJ, Baron TH, García-Cano J, Cheon JH, Lee MS, Kwon SH, Mucci-Hennekinne S, Fockens P, Dijkgraaf MGW, Repici A. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc 2014; 79:970-82.e7; quiz 983.e2, 983.e5. [PMID: 24650852 DOI: 10.1016/j.gie.2013.11.038] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 11/25/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies suggest that there is a substantial risk of perforation after colorectal stent placement. OBJECTIVE To identify risk factors for perforation from colonic stenting. DESIGN A meta-analysis of 86 studies published between 2005 and 2011. SETTING Multicenter review. PATIENTS All patients who underwent colorectal stent placement. INTERVENTION Colorectal stent placement. MAIN OUTCOME MEASUREMENTS The occurrence of perforation with subgroup analyses for stent design, stricture etiology, stricture dilation, and concomitant chemotherapy, including the use of bevacizumab. RESULTS A total of 4086 patients underwent colorectal stent placement; perforation occurred in 207. Meta-analysis revealed an overall perforation rate of 7.4%. Of the 9 most frequently used stent types, the WallFlex, the Comvi, and the Niti-S D-type had a higher perforation rate (>10%). A lower perforation rate (<5%) was found for the Hanarostent and the Niti-S covered stent. Stenting benign strictures was associated with a significantly increased perforation rate of 18.4% compared with 7.5% for malignant strictures. Dilation did not increase the risk of perforation: 8.5% versus 8.5% without dilation. The subgroup of post-stent placement dilation had a significantly increased perforation risk of 20.4%. With a perforation rate of 12.5%, bevacizumab-based therapy was identified as a risk factor for perforation, whereas the risk for chemotherapy without bevacizumab was 7.0% and not increased compared with the group without concomitant therapies during stent therapy (9.0%). LIMITATIONS Heterogeneity; a considerable proportion of data is unavailable for subgroup analysis. CONCLUSIONS The perforation rate of colonic stenting is 7.4%. Stent design, benign etiology, and bevacizumab were identified as risk factors for perforation. Intraprocedural stricture dilation and concomitant chemotherapy were not associated with an increased risk of perforation.
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Affiliation(s)
- Emo E van Halsema
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Aaron J Small
- Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Todd H Baron
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jesús García-Cano
- Department of Gastroenterology, Hospital Virgen de la Luz, Cuenca, Spain
| | - Jae Hee Cheon
- Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Sung Lee
- Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Se Hwan Kwon
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Korea
| | | | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Alessandro Repici
- Department of Digestive Endoscopy, Istituto Clinico Humanitas, Milan, Italy
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Own experiences of endoscopic self-expandable stent placement for malignant colorectal ileus. Wideochir Inne Tech Maloinwazyjne 2014; 9:59-63. [PMID: 24729811 PMCID: PMC3983551 DOI: 10.5114/wiitm.2014.40390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/19/2013] [Accepted: 06/30/2013] [Indexed: 12/16/2022] Open
Abstract
Introduction Acute low neoplasm ileus requires emergency surgery. Nowadays there are increased numbers of patients with comorbidities, which causes higher risk of intra- and postoperative complications. Aim To evaluate the clinical usefulness of endoscopic self-expandable stent placement for malignant colorectal ileus. Material and methods Twenty-one patients (8 women and 13 men), mean age 66.7 years, with low neoplasm obstruction, underwent endoscopic stenting of the stricture. This procedure was performed as a bridge to the surgery especially for high-risk patients. Eight of them had coagulation system impairment, 5 severe metabolic disorders, 4 circulatory insufficiency, 3 severe malnutrition and 1 patient undiagnosed synchronic rectal tumor. In 10 patients cancer was located in the sigmoid colon, in 7 in the rectum, in 2 in the ascending colon, and the transverse and ascending colon was involved in another 2 patients. Results All 21 patients (100%) underwent endoscopic stenting successfully. There were no complications after stent placement. The authors underline that placement of expandable metallic stents for patients with malignant colon obstruction with acute ileus is a safe and effective method. It gives an opportunity for quick balance of fluid, electrolyte, and the coagulation system and improvement of efficiency of the circulatory and respiratory system. Conclusions Endoscopic treatment of ileus helps precisely estimate tumor advancement and gives the possibility of a single stage radical surgical procedure.
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Cheung DY, Lee YK, Yang CH. Status and literature review of self-expandable metallic stents for malignant colorectal obstruction. Clin Endosc 2014; 47:65-73. [PMID: 24570885 PMCID: PMC3928494 DOI: 10.5946/ce.2014.47.1.65] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/18/2013] [Accepted: 07/18/2013] [Indexed: 12/14/2022] Open
Abstract
Use of colorectal stents has increased dramatically over the last decades. Colorectal stents offer an alternative way to relieve fatal intestinal obstruction and can take place of emergency surgery, which associated with significant morbidity and mortality and a high incidence of stoma creation, to elective resection. Although there remain a few concerns regarding the use of stents as a bridge to surgical resection, use of self-expandable metallic stents for palliation in patients with unresectable disease has come to be generally accepted. Advantages of colorectal stents include acute restoration of luminal patency and allowance of time for proper staging and surgical optimization, and the well-known disadvantages are procedure-related complications including perforation, migration, and stent failure. General indications, procedures, and clinical outcomes as well as recent evidences regarding the use of colorectal stents will be discussed in this review.
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Affiliation(s)
- Dae Young Cheung
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong Kook Lee
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Chang Heon Yang
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
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The efficacy of self-expanding metal stents for malignant colorectal obstruction by noncolonic malignancy with peritoneal carcinomatosis. Dis Colon Rectum 2013; 56:1228-32. [PMID: 24104996 DOI: 10.1097/dcr.0b013e3182a411e7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although self-expanding metal stents for colorectal obstruction is preferred over emergency surgery, the efficacy of self-expanding metal stents in patients with malignant colorectal obstruction by a noncolonic malignancy with peritoneal carcinomatosis has not been demonstrated. OBJECTIVE The aim of this study was to evaluate the survival and long-term clinical outcome of self-expanding metal stents as the initial interventional approach in patients with malignant colorectal obstruction due to a noncolonic malignancy with peritoneal carcinomatosis. DESIGN This is a retrospective study. SETTINGS This study was conducted at 2 tertiary care academic medical centers in South Korea. PATIENTS The patients were included who underwent self-expanding metal stent insertion for palliation of a malignant colorectal obstruction by a noncolonic malignancy with peritoneal carcinomatosis between July 2004 and January 2010. Inclusion criteria were incurable status, noncolorectal cancer, obstructive symptoms and/or signs, and colonoscopic findings of obstruction. MAIN OUTCOME MEASURES The survival and success rate of patients undergoing self-expanding metal stents insertion was assessed. RESULTS Twenty patients were included during the study period. Technical success of self-expanding metal stents was achieved in 18/20 (90.0%) patients, and obstructive symptoms were resolved within 72 hours in 17/20 (85.0%) patients. Ten patients (10/20, 50%) did not need further intervention during the follow-up period after the first stent insertion. Eight patients ultimately underwent surgery during the follow-up period. One of the remaining 2 patients underwent additional endoscopic treatment without surgery. Another patient refused further intervention and thus received conservative management. Mean event-free survival was 119.0 days, and the mean overall survival of the included patients was 156.3 days. LIMITATION The number of study patients was small. CONCLUSION Self-expanding metal stent insertion appears to be a reasonable first-treatment option in patients with malignant colorectal obstruction by noncolonic malignancy with peritoneal carcinomatosis.
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Lee KJ, Kim SW, Kim TI, Lee JH, Lee BI, Keum B, Cheung DY, Yang CH. Evidence-based recommendations on colorectal stenting: a report from the stent study group of the korean society of gastrointestinal endoscopy. Clin Endosc 2013; 46:355-67. [PMID: 23964332 PMCID: PMC3746140 DOI: 10.5946/ce.2013.46.4.355] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 10/13/2012] [Accepted: 10/29/2012] [Indexed: 12/11/2022] Open
Abstract
Recently, placement of self-expandable metallic stents has been used for the treatment of colorectal obstruction. As domestic awareness of colorectal cancer has increased, the number of colorectal stenting procedures performed has also increased. We aimed to provide evidence-based recommendations for colorectal stenting to aid gastroenterologists in making informed decisions regarding the management of patients who present with colorectal obstruction. The working group consisted of eight gastroenterologists who actively practice and conduct research in the field of colorectal stenting and are the members of the Stent Study Group of the Korean Society of Gastrointestinal Endoscopy. A literature search was conducted using the PubMed, Embase, KoreaMed, and the Cochrane Library databases to identify relevant articles published between January 2001 and June 2012. Based on the modified Delphi process, 10 recommendation statements regarding indications, usefulness, methodology and complications of colorectal stenting, and alternative treatments for malignant colorectal obstruction were determined. The contents will be widely distributed, and periodically revised to reflect the latest knowledge. These evidence-based recommendations for colorectal stenting will provide gastroenterologists and patients with appropriate and balanced information, and will improve the quality of care.
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Affiliation(s)
- Kwang Jae Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
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Sarkar S, Geraghty J, Rooney P. Colonic stenting: a practical update. Frontline Gastroenterol 2013; 4:219-226. [PMID: 28839728 PMCID: PMC5369802 DOI: 10.1136/flgastro-2012-100286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 01/31/2013] [Accepted: 02/07/2013] [Indexed: 02/04/2023] Open
Abstract
Colonic stenting is part of the UK service provision guidelines for colorectal cancer. However, there are issues about availability and expertise within the UK, and controversies remain regarding various clinical and technical aspects of the technique. Based on the current evidence, this article will provide a practical update on the indications, the clinical and technical considerations and the remaining unanswered questions regarding colonic stenting.
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Affiliation(s)
- Sanchoy Sarkar
- Department of Gastroenterology and Hepatology, Royal Liverpool University Hospital, Liverpool, UK,Department of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Joe Geraghty
- Department of Gastroenterology and Hepatology, Royal Liverpool University Hospital, Liverpool, UK,Department of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Paul Rooney
- Department of Surgery, Royal Liverpool University Hospital, Liverpool, UK
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Okugawa T, Oshima T, Ikeo K, Kondo T, Tomita T, Fukui H, Watari J, Miwa H. Successful Self-Expandable Metallic Stent Placement for a Case of Distal Rectal Stenosis due to Gastric Cancer Metastasis. Case Rep Gastroenterol 2013; 7:214-8. [PMID: 23741209 PMCID: PMC3670628 DOI: 10.1159/000351818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A 47-year-old woman was diagnosed as having advanced gastric cancer with malignant ascites. Despite chemotherapy, recurrent peritoneal dissemination was seen 1.5 years after operation. A computed tomography scan revealed rectal stenosis due to Schnitzler's metastasis. When the distance from the distal end of the obstruction to the anal verge is less than 5 cm, stent replacement has been said to be contraindicated due to the development of anal pain and foreign body sensation. Although the distance from the distal end of the obstruction to the anal verge was 4 cm in this case, a WallFlexTM colonic stent could be placed. She stayed home, and luminal patency remained until she died 270 days after stent insertion. This report demonstrates that rectal obstruction located less than 5 cm from the anal verge due to Schnitzler's metastasis could be treated by stenting without any symptomatic or technical complications.
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Affiliation(s)
- Takuya Okugawa
- Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Ding XL, Li YD, Yang RM, Li FB, Zhang MQ. A temporary self-expanding metallic stent for malignant colorectal obstruction. World J Gastroenterol 2013; 19:1119-1123. [PMID: 23467379 PMCID: PMC3582001 DOI: 10.3748/wjg.v19.i7.1119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/11/2013] [Accepted: 01/24/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical safety and efficacy of a temporary self-expanding metallic stent (SEMS) for malignant colorectal obstruction.
METHODS: From September 2007 to June 2012, 33 patients with malignant colorectal obstruction were treated with a temporary SEMS. The stent had a tubular configuration with a retrieval lasso attached inside the proximal end of the stent to facilitate its removal. The SEMS was removed one week after placement. Clinical examination, abdominal X-ray and a contrast study were prospectively performed and both initial and follow-up data before and at 1 d, 1 wk, and 1 mo, 3 mo, 6 mo and 12 mo after stent placement were obtained. Data collected on the technical and clinical success of the procedures, complications, need for reinsertion and survival were analyzed.
RESULTS: Stent placement and removal were technically successful in all patients with no procedure-related complications. Post-procedural complications included stent migration (n = 2) and anal pain (n = 2). Clinical success was achieved in 31 (93.9%) of 33 patients with resolution of bowel obstruction within 3 d of stent removal. Eleven of the 33 patients died 73.81 ± 23.66 d (range 42-121 d) after removal of the stent without colonic re-obstruction. Clinical success was achieved in another 8 patients without symptoms of obstruction during the follow-up period. Reinsertion of the stent was performed in the remaining 12 patients with re-obstruction after 84.33 ± 51.80 d of follow-up. The mean and median periods of relief of obstructive symptoms were 97.25 ± 9.56 d and 105 ± 17.43 d, respectively, using Kaplan-Meier analysis.
CONCLUSION: Temporary SEMS is a safe and effective approach in patients with malignant colorectal obstruction due to low complication rates and good medium-term outcomes.
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Favorable long-term clinical outcome of uncovered D-weave stent placement as definitive palliative treatment for malignant colorectal obstruction. Dis Colon Rectum 2012; 55:983-9. [PMID: 22874606 DOI: 10.1097/dcr.0b013e31825c484d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Most self-expandable metallic stents for colorectal placement are uncovered because of the high migration rate of covered stents. However, the optimal stent design for colorectal use remains unclear. OBJECTIVE The purpose of this study was to evaluate the efficacy and safety of a double-wire woven uncovered stent for definitive palliative treatment of malignant colorectal obstruction. DESIGN This study was a prospective, single-arm, observational clinical study of patients enrolled between December 2005 and September 2010. SETTINGS This study was conducted at a referral hospital in Japan. PATIENTS Twenty-four consecutive patients with malignant colorectal obstruction were included in the study. INTERVENTIONS A double-wire woven uncovered stent was placed by use of a standard through-the-scope endoscopic placement technique. MAIN OUTCOME MEASURES Technical, initial clinical, and long-term clinical success were measured. Long-term clinical success was defined as sustained relief of obstructive symptoms without reintervention until the patient's death. RESULTS The Karnofsky performance status score before stent placement was 60 (median, interquartile range, 42.5-67.5). Twenty of 24 patients had primary colorectal cancer, and 4 had extracolorectal malignancies. The site of obstruction was the ascending colon in 10 patients, descending colon in 4 patients, sigmoid colon in 7 patients, and rectum in 3 patients. Technical, initial, and long-term clinical success rates were 100%, 100%, and 83%. Median stent patency time was 149 days (interquartile range, 45-198 days). Median survival time after stent placement was 155 days (interquartile range, 68-231 days). Four patients (17%) had negative outcomes including stent occlusion by tumor ingrowth (8%) and stent migration (8%). The highest Karnofsky performance status score after stent placement was 70 (median; interquartile range, 50-70). The Karnofsky performance status score improved after stent placement (p = 0.002). LIMITATIONS This study was limited because it was a single-arm, single-center study, and it had a small sample size. CONCLUSIONS Endoscopic placement of double-wire woven uncovered stents is effective and safe as definitive palliative treatment for patients with malignant colorectal obstruction.
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Kim JY, Kim SG, Im JP, Kim JS, Jung HC. Comparison of treatment outcomes of endoscopic stenting for colonic and extracolonic malignant obstruction. Surg Endosc 2012; 27:272-7. [PMID: 22773238 DOI: 10.1007/s00464-012-2439-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 05/31/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Self-expandable metal stents (SEMS) have been used as a bridging or palliative treatment for malignant colorectal obstruction. Colonic obstruction also may arise from advanced extracolonic malignancy, but the clinical outcomes of stent placement for extracolonic malignancy are unclear. This study compared the clinical outcomes of SEMS between patients with colorectal cancer and those with extracolonic malignancy. METHODS Patients who underwent endoscopic SEMS placement for a malignant colorectal obstruction were enrolled at Seoul National University Hospital from April 2005 and August 2011. Their medical records were retrospectively reviewed in terms of success rate, complications, and duration of stent patency. RESULTS Endoscopic SEMS placements were performed for colorectal cancer in 149 patients and for extracolonic malignancy in 60 patients. The causes of obstruction in extracolonic malignancy were advanced gastric cancer in 39 patients (65%), pancreatic cancer in nine patients (15%), ovarian cancer in three patients (5%) and other causes in nine patients (15%). The clinical success rates were similar between the two groups (92.6 vs 86.7%; p = 0.688), and multivariate analysis showed no significant risk factor for unsuccessful endoscopic SEMS placement. Reobstruction in palliative endoscopic SEMS placement occurred for 16 patients with colorectal cancer (21.9%) and 18 patients with extracolonic malignancy (30%) during a median follow-up period of 90 days (p = 0.288). The rates did not differ significantly between the two groups (4.1 vs 8.3%; p = 0.467). The median duration of stent patency was 193 ± 42 days for the patients with colorectal cancer and 186 ± 31 days for the patients with extracolonic malignancy (p = 0.253). The duration of stent patency was not affected by underlying malignancy, previous surgery, or palliative chemotherapy. CONCLUSIONS Endoscopic SEMS placement is highly effective and comparable for palliation of obstruction in extracolonic malignancy and colorectal cancer in terms of clinical success, complications, and duration of patency.
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Affiliation(s)
- Ji Yeon Kim
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine and Hospital, Seoul, Korea.
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Jung IS, Kim SY, Kim KS, Ko KH, Sung JK, Jeong HY, Kim JY, Moon HS. A case of primary ovarian lymphoma presenting as a rectal submucosal tumor. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2012; 28:111-5. [PMID: 22606652 PMCID: PMC3349809 DOI: 10.3393/jksc.2012.28.2.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 10/31/2011] [Accepted: 11/23/2011] [Indexed: 11/20/2022]
Abstract
Primary ovarian lymphoma is a rare malignancy whose symptoms or signs are usually nonspecific. In this article, we report a very rare case initially presenting as a rectal submucosal-tumor-like lesion with a defecation disturbance caused by primary ovarian lymphoma with bilateral involvement. A 42-year-old woman visited chungnam national university hospital complaining of persistent defecation disturbance for 6 months. Colonoscopy demonstrated compression of the rectum by an extrinsic mass mimicking a rectal submucosal tumor. Magnetic resonance imaging detected bilateral ovarian tumors, 9.3 cm and 5.4 cm each in diameter, compressing the rectum without enlarged lymph nodes. The diagnosis was established following a bilateral adnexectomy and histological studies of the excised tissue. The tumor was classified as a diffuse large B-cell lymphoma. The patient was prescribed six cycles of standard CHOP (cyclophosphamide, hydroxydaunorubicin, vincristine, prednisolone) regimen and is presently on treatment.
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Affiliation(s)
- Il Soon Jung
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
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Kim BC, Han KS, Hong CW, Sohn DK, Park JW, Park SC, Kim SY, Baek JY, Choi HS, Chang HJ, Kim DY, Oh JH. Clinical outcomes of palliative self-expanding metallic stents in patients with malignant colorectal obstruction. J Dig Dis 2012; 13:258-66. [PMID: 22500788 DOI: 10.1111/j.1751-2980.2012.00564.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Self-expanding metallic stents (SEMS) are useful palliative option and a bridge to surgery in malignant colorectal obstruction. The aim of this study was to evaluate the clinical outcomes of SEMS to palliate colorectal malignant obstruction. METHODS Malignant colorectal obstructive patients who underwent SEMS insertion at the National Cancer Center, Korea from January 2004 to June 2008 were enrolled in the study. Patients' clinical characteristics, outcomes and complications for palliative SEMS insertion were retrospectively analyzed. RESULTS A total of 54 patients were enrolled in the palliative SEMS group and 48 patients with obstructive CRC were included in the SEMS as the bridge to surgery group. Obstruction of the left colon occurred in 52 patients of the palliative SEMS group and all patients in SEMS as bridge to surgery group. For primary SEMS insertion, the technical success (TS) rate was 87.0% and the clinical success (CS) rate 89.4%, while the rates of early and late complications were 24.1% and 23.4%, respectively. There was no procedure-related mortality. Stent migration rate was higher in the cases treated with small diameter and covered type of stents. Median time to reobstruction and migration were 85 and 101 days, respectively. TS and CS rates for SEMS reinsertion were comparable to those for primary SEMS insertion. CONCLUSIONS Palliative SEMS are effective and favorable procedures for malignant colorectal obstruction but with some complications. Stent migration is associated with covered type and small diameter stents while other factors including length of stent and chemotherapy do not affect stent complications in the present study.
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Affiliation(s)
- Byung Chang Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Korea.
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Kim BK, Hong SP, Heo HM, Kim JY, Hur H, Lee KY, Cheon JH, Kim TI, Kim WH. Endoscopic stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery. Gastrointest Endosc 2012; 75:294-301. [PMID: 22154416 DOI: 10.1016/j.gie.2011.09.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 09/14/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although self-expandable metal stent (SEMS) insertion has been shown to be an effective therapy for palliation of obstruction from colorectal malignancy, the clinical efficacy of SEMS insertion in the palliation of colorectal obstruction from an extracolonic malignancy (ECM) has not been extensively evaluated. OBJECTIVE The aim of this study was to evaluate the clinical outcomes and complications of SEMSs compared with those of emergency surgery for relief of colorectal obstruction in patients with advanced gastric cancer (AGC). DESIGN Retrospective study. PATIENTS From January 2000 to December 2009, patients with AGC who were treated with SEMSs (N = 111) or emergency surgery (N = 69) for palliation of malignant colorectal obstruction were included. INTERVENTION SEMS insertion or surgery. RESULTS Although acute complications and stoma formations were lower in the SEMS group than in the surgery group, the clinical efficacy of SEMSs was inferior to emergency surgery (technical success, 73.9% vs 94.2%, P = .001; clinical success, 54.1% vs 75.4%, P = .005). SEMS-related complications occurred in 64.5%, including reobstruction (36.8%), stent migration (10.5%), perforation (13.2%), and bleeding (3.9%). The median duration of patency was not statistically different between the patients who underwent SEMS insertion and those who underwent emergency surgery (117 days vs 183 days, P = .105). Patients with fewer than 2 obstructive sites or less than 2 years to obstructive symptom onset after diagnosis of AGC showed better clinical outcomes after endoscopic stenting. LIMITATIONS Retrospective and single-center study. CONCLUSIONS SEMS insertion seems to be less effective than emergency surgery for the palliation of colorectal obstruction in patients with AGC. Further study is necessary to define those patients with ECM who may benefit from SEMS insertion.
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Affiliation(s)
- Bo Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Kim SK, Lee CH, Lee MR, Kim JH. Multivariate Analysis of the Survival Rate for Treatment Modalities in Incurable Stage IV Colorectal Cancer. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2012; 28:35-41. [PMID: 22413080 PMCID: PMC3296940 DOI: 10.3393/jksc.2012.28.1.35] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/03/2011] [Accepted: 09/15/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this study was to compare survival in patients that underwent palliative resection treatment versus non-resection for incurable colorectal cancer (ICRC). METHODS The case records of 201 patients with ICRC between January 2000 and December 2009 were reviewed. Demographics, American Society of Anesthesiologists (ASA) score, carcinoembryonic antigen (CEA) level, the location of the colon cancer, histology, metastasis, treatment options and median survival were analyzed retrospectively. We divided the patients into four groups according to the treatment modalities: resection alone, resection with post-operative chemotherapy, non-resection treatment by chemotherapy alone, and stent or bypass. Median survival times were compared according to each treatment option, and the survival rates were analyzed. RESULTS 105 patients underwent palliative resection whereas 96 were treated with non-resection modalities. A palliative resection was performed in 44 cases for resection alone and in 61 cases for resection with post-operative chemotherapy. In patients treated with non-resection of the primary tumor, chemotherapy alone was done in 65 cases and stent or bypass in 31 cases. Multivariate analysis showed a median survival of 14 months in patients with palliative resections with post-operative chemotherapy, which was significantly higher than those for chemotherapy alone (8 months), primary tumor resection alone (5 months), and stent or bypass (5 months). Gender, age, ASA score, CEA level, the location of colon cancer, histology and the presence of multiple metastases were not independent factors in association with the median survival rate. CONCLUSION In the treatment of ICRC, palliative resection followed by post-operative chemotherapy shows the most favorable median survival compared to other treatment options.
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Affiliation(s)
- Sung Kang Kim
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Chang Ho Lee
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Min Ro Lee
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Jong Hun Kim
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
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Steinkamp M, Gress TM. Endoskopische Möglichkeiten der Behandlung von Nahtinsuffizienzen im Rektum. Visc Med 2012. [DOI: 10.1159/000345837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
<b><i>Hintergrund: </i></b>Anastomoseninsuffizienzen stellen eine gefürchtete Komplikation der kolorektalen Chirurgie dar. Endoskopische Techniken haben sich in der Therapie der Leckagen zunehmend etabliert. In dieser Übersicht möchten wir einen Überblick der wichtigsten endoskopischen Verfahren geben. <b><i>Methode: </i></b>Systematische Recherche der vorhandenen Literatur. <b><i>Ergebnisse: </i></b>Die bedeutendsten endoskopischen Verfahren zur Behandlung der kolorektalen Anastomoseninsuffizienzen stellen die Fibrininjektion, die Vakuumschwammtherapie (Endo-Sponge), spezielle Clip-Systeme (OTSC) sowie die Stentimplantation dar. Der breiten klinischen Anwendung dieser Verfahren steht jedoch eine unzureichende Studienlage gegenüber. <b><i>Schlussfolgerung: </i></b>Die Einschätzung der Wertigkeit der einzelnen endoskopischen Verfahren untereinander und in speziellen therapeutischen Situationen hängt im Wesentlichen von der Erfahrung der Untersucher ab. Es bedarf der Durchführung randomisierter, prospektiver Studien, um diese Erfahrungen zu objektivieren.
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Chou SQH, Song HY, Kim JH, Park JH, Fan Y, Lee H, Yoon YS, Kim JC. Dual-design expandable colorectal stent for a malignant colorectal obstruction: preliminary prospective study using new 20-mm diameter stents. Korean J Radiol 2011; 13:66-72. [PMID: 22247638 PMCID: PMC3253405 DOI: 10.3348/kjr.2012.13.1.66] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 09/01/2011] [Indexed: 12/30/2022] Open
Abstract
Objective To evaluate the safety and effectiveness of a 20-mm diameter dual-design expandable colorectal stent for malignant colorectal obstruction. Materials and Methods The study series included 34 patients with malignant colorectal obstruction who underwent implantation of a 20-mm dual-design expandable colorectal stent in our department between March 2009 and June 2010. The 20-mm dual-design expandable colorectal stent was placed by using a 3.8-mm delivery system that had 28-mm diameter proximal and distal ends. Among the 34 patients, stent placement for palliation was performed in 20 patients, while stent placement for bridge to surgery was performed in 14 patients. Results A 97% (33 of 34) success rate was achieved for the stent placement. The perforation rate in the bridge to surgery group was 7% (1 of 14), compared to 0% (0 of 19) in palliative group. Migration occurred in one of 33 patients (3%) at 30 days after stent placement. Conclusion The placement of a 20-mm diameter dual-design stent appears to be clinically safe and effective for the management of colorectal obstruction, with low perforation and migration rates.
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Affiliation(s)
- Sandas Qi Hua Chou
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
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Yoon JY, Jung YS, Hong SP, Kim TI, Kim WH, Cheon JH. Clinical outcomes and risk factors for technical and clinical failures of self-expandable metal stent insertion for malignant colorectal obstruction. Gastrointest Endosc 2011; 74:858-68. [PMID: 21862005 DOI: 10.1016/j.gie.2011.05.044] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 05/26/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although self-expandable metal stent (SEMS) insertion is widely used for relief of malignant colorectal obstructions, the immediate technical and clinical failure rates of SEMSs and the associated risk factors remain largely unknown. OBJECTIVE To identify rates and factors predictive of technical and clinical failure of SEMSs when their use is attempted for the decompression of malignant colorectal obstruction. DESIGN Retrospective chart review. SETTING A tertiary-care academic medical center in South Korea. PATIENTS This study involved a total of 412 patients with malignant colorectal obstruction in whom SEMS insertion was attempted. INTERVENTION Placement of colonic SEMSs. MAIN OUTCOME MEASUREMENTS Technical success and immediate and long-term clinical success rates. RESULTS Technical and clinical failures were found in 36 of 276 patients (13.0%) and 39 of 240 patients (16.3%) in the palliative group, respectively, and in 3 of 136 patients (2.2%) and 7 of 133 patients (5.3%) in the preoperative group, respectively. Factors associated with technical failure were extracolonic origin of tumor, the presence of carcinomatosis, and a proximal obstruction site. Factors associated with long-term clinical failure in the palliative group were combined dilation procedure, no additional chemotherapy, and extracolonic origin of the tumor. In the preoperative group, only older patients had both higher technical failure and clinical failure rates. LIMITATIONS This was a single-institution, retrospective analysis. CONCLUSION Although colorectal SEMS placement is generally safe and effective, it is associated with clinically important technical and clinical failure rates. The identification of risk factors for the failure of colorectal SEMSs found in this study might help physicians decide between surgical decompression and endoscopic stenting in patients with malignant colorectal obstruction.
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Affiliation(s)
- Jin Young Yoon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Metallic stent placement in the palliative treatment of malignant colonic obstructions: primary colonic versus extracolonic malignancies. J Vasc Interv Radiol 2011; 22:1727-32. [PMID: 21937243 DOI: 10.1016/j.jvir.2011.08.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 07/26/2011] [Accepted: 08/02/2011] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To compare retrospectively clinical outcomes in patients who underwent metallic stent placement for colonic obstruction caused by colonic or extracolonic malignancies. MATERIALS AND METHODS Palliative stent placement was performed for inoperable malignant colonic obstruction in 108 patients, including 58 for primary colorectal cancer and 50 for extracolonic malignancies including gastric (n = 31), pancreatic (n = 8), ovarian (n = 4), bladder (n = 2), bile duct (n = 1), gallbladder (n = 1), breast (n = 1), esophageal (n = 1), and renal (n = 1) cancers. RESULTS Technical (84% vs 94%, P = .137) and clinical (98% vs 96%, P = .533) success rates of stent placement were similar in patients with primary colorectal cancer and patients with extracolonic malignancies. Rates of perforation, stent migration, tumor overgrowth, bleeding, and pain did not differ significantly between groups of patients with primary colorectal cancer and extracolonic malignancies. The median symptom-free survival periods were 4 months in patients with primary colorectal cancer and 3 months in patients with extracolonic malignancies (P = .072). CONCLUSIONS Metallic stent placement was clinically effective in the palliative treatment of colonic obstructions in patients with primary colorectal cancer and patients with extracolonic malignancies.
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Al Samaraee A, McCallum IJ, Kenny L, Isreb S, Macdougall L, Hayat M, Kelly S. Colorectal stents: do we have enough evidence? Int J Surg 2011; 9:595-9. [PMID: 21930255 DOI: 10.1016/j.ijsu.2011.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 08/29/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND The use of colonic stents has significantly evolved over the last few years. Emergency surgery for colonic obstructions is usually associated with significant mortality, morbidity and often stoma formation. Colonic stents provide an alternative way to relieve colonic obstruction, and hence avoiding the risks associated with emergency surgery. This literature review aims to summarize the important current evidence regarding colorectal stenting and show whether further evaluation of the procedure is required. RESULTS The available large number of non-randomized studies suggests that Self-Expandable-Metal-Stents (SEMS) placement for acute colonic obstruction could be considered as safe and effective alternative to surgery in experienced hands either as a bridge to surgery or as a palliative measure. This evidence has led to SEMS being widely adopted. However, randomized evidence has begun to show the defects that are inherent in the low level evidence that has so far supported SEMS use and it may be that reports of randomized controlled trials may clarify the patient population where SEMS placement is appropriate. CONCLUSION While we are still waiting for the outcome of the multicentre randomized controlled trials in the UK and Europe, clinicians must be aware of the current evidence limitations and apply SEMS use pragmatically.
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Affiliation(s)
- Ahmad Al Samaraee
- North Tyneside General Hospital, Mr. S. Kelly's Office, Rake Lane, North Shields, NE29 8NH, UK.
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Keränen I, Lepistö A, Udd M, Halttunen J, Kylänpää L. Stenting for malignant colorectal obstruction: a single-center experience with 101 patients. Surg Endosc 2011; 26:423-30. [PMID: 21909857 DOI: 10.1007/s00464-011-1890-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 08/15/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Self-expanding metal stents (SEMS) are used for colorectal obstruction preoperatively and palliatively. Limited data on the use of stents for obstruction caused by extracolonic malignancies exist, and the results are unclear. Our goal was to evaluate the efficacy and safety of SEMS for patients stented as a bridge to surgery and as palliation for colorectal cancer or extracolonic malignancies. METHODS Between 1998 and 2009, a total of 101 patients underwent 108 stenting procedures for malignant colorectal obstruction. The results were studied retrospectively. RESULTS Of the study cohort, 11 patients were stented as a bridge to surgery. For palliatively stented patients, the etiology of obstruction was colorectal cancer in 66 patients and extracolonic malignancy in 24. Overall technical success was 99% and clinical success 88%. Complications occurred for 20 (20%) patients in 22 of 108 procedures. Complications included perforation (n = 6), recurrent obstruction (n = 8), and stent migration (n = 4). A median time to complication was 81.5 days. The overall stent placement-related mortality was 2/101 (2%). For patients stented as a bridge to surgery, a primary anastomosis in elective operations was achieved for 90% (9/10). In the palliation groups, patients with colorectal cancer had significantly higher clinical success rates than patients with extracolonic malignancies (94% vs. 65%, P = 0.0005). There was no difference in complications, operation, and stoma rates between the palliation groups. CONCLUSIONS SEMS is a safe and effective treatment for patients stented as a bridge to surgery or as palliation due to colorectal cancer. Stents are also useful in relieving obstruction due to extracolonic malignancies, but the clinical failure rate is higher than for colorectal cancer.
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Affiliation(s)
- Ilona Keränen
- Department of Gastrointestinal and General Surgery, Helsinki University Central Hospital, P.O. Box 340, 00029, HUS, Finland.
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Varadarajulu S, Banerjee S, Barth B, Desilets D, Kaul V, Kethu S, Pedrosa M, Pfau P, Tokar J, Wang A, Song LMWK, Rodriguez S. Enteral stents. Gastrointest Endosc 2011; 74:455-64. [PMID: 21762904 DOI: 10.1016/j.gie.2011.04.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 04/06/2011] [Indexed: 02/08/2023]
Abstract
The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through August 2010 for articles related to enteral, esophageal, duodenal, and colonic stents. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.
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