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Ishibashi R, Sasaki T, Isayama H, Matsuzawa T, Kuwai T, Yamada T, Saito S, Tomita M, Shiratori T, Ikeda S, Kanazawa H, Fujishiro M, Maetani I, Saida Y. A Japanese Prospective, Multicenter Study of Colonic Stenting for Palliation Using a High Axial Force Self-Expandable Metal Stent for Malignant Large Bowel Obstruction in 200 Patients. J Clin Med 2023; 12:5134. [PMID: 37568537 PMCID: PMC10419878 DOI: 10.3390/jcm12155134] [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: 05/22/2023] [Revised: 06/10/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Evidence of the efficacy and safety of colorectal stent placement for palliation remains insufficient. This single-arm, prospective, multicenter study with a WallFlex enteral colonic stent included 200 consecutive patients with malignant large bowl obstruction in the palliation cohort. The technical and clinical success, as well as stent patency and complications as short-term (≤7 days) and long-term (>7 days) outcomes, of high axial force self-expandable metal stent (SEMS) placement was evaluated. The technical and clinical success rates were 98.5% and 94.5%, respectively. Non-recurrent colorectal obstruction at 1 year was 63.9%, and 71.2% of the patients remained free of recurrent colorectal obstruction until death or the last follow-up. Fifty-six patients (28.0%) received chemotherapy, and five patients were administered bevacizumab after stent placement. The overall complication rate was 47%, including four (2.0%) early-onset and ten (5.0%) late-onset perforations, mostly due to stent-edge injury. Only the use of a long SEMS was a risk factor for perforation. In conclusion, endoscopic colorectal stenting using high axial force SEMS is an effective and safe procedure for palliation in patients with malignant colorectal obstruction. However, care should be taken to avoid perforation at the stent edge when using a long SEMS.
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Affiliation(s)
- Rei Ishibashi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (R.I.); (M.F.)
| | - Takashi Sasaki
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan;
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan
| | - Takeaki Matsuzawa
- Department of Surgery, Imusumiyoshi General Hospital, Saitama 354-0041, Japan;
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima 737-0023, Japan;
| | - Tomonori Yamada
- Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi 466-8650, Japan;
| | - Shuji Saito
- Department of Surgery, Gastrointestinal Center, Yokohama Shin-Midori General Hospital, Kanagawa 226-0025, Japan;
| | - Masafumi Tomita
- Department of Surgery, Kobe Tokushukai Hospital, Hyogo 655-0017, Japan;
| | - Toshiyasu Shiratori
- Department of Gastroenterology, Kameda Medical Center, Chiba 296-8602, Japan;
| | - Satoshi Ikeda
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan;
| | - Hideki Kanazawa
- Department of Surgery, National Hospital Organization Sagamihara Hospital, Kanagawa 252-0392, Japan;
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (R.I.); (M.F.)
| | - Iruru Maetani
- Department of Gastroenterology, Sin-Kuki General Hospital, Saitama 346-8530, Japan;
| | - Yoshihisa Saida
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan;
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Kim EM, Park JH, Kim BC, Son IT, Kim JY, Kim JW. Self-expandable metallic stents as a bridge to surgery in obstructive right- and left-sided colorectal cancer: a multicenter cohort study. Sci Rep 2023; 13:438. [PMID: 36624310 PMCID: PMC9829682 DOI: 10.1038/s41598-023-27767-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
The insertion of a self-expandable metal stent (SEMS) has been proposed as an alternative to emergent surgery (ES) for obstructive colorectal cancer (CRC). We aimed to evaluate the perioperative and oncologic outcomes of SEMS as a bridge to surgery in obstructive CRC, as compared with ES. We retrospectively reviewed the medical records of patients who underwent curative resection of obstructive CRC at four Hallym University-affiliated hospitals between January 2010 and December 2019. All patients were analyzed overall colon, then according to the side of obstruction (overall, right or left). Of 167 patients, 52 patients underwent ES and 115 underwent SEMS insertion and surgery (SEMS group). The postoperative hospital stay and time to soft diet were shorter in the SEMS group than in the ES group for overall and both sided cancer. The SEMS group had lower rates of stoma formation and severe complications for overall and for left-sided cancer. The 5-year overall survival (P = 0.682) and disease-free survival (P = 0.233) rates were similar in both groups. SEMS insertion as a bridge to surgery was associated with faster recovery, a lower rate of stoma formation with similar oncologic outcomes to those of ES.
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Affiliation(s)
- Eui Myung Kim
- grid.256753.00000 0004 0470 5964Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40, Sukwoo-Dong, Hwaseong-Si, Gyeonggi-Do 445-170 Republic of Korea
| | - Jun Ho Park
- grid.256753.00000 0004 0470 5964Department of Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 445 Gil-1-dong, Gangdong-gu, Seoul, 134-701 Republic of Korea
| | - Byung Chun Kim
- grid.256753.00000 0004 0470 5964Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, 1, Shingil-ro, Yeongdeungpo-gu, Seoul, 150-950 Republic of Korea
| | - Il Tae Son
- grid.256753.00000 0004 0470 5964Department of Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang Si, 445-907 Republic of Korea
| | - Jeong Yeon Kim
- grid.256753.00000 0004 0470 5964Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40, Sukwoo-Dong, Hwaseong-Si, Gyeonggi-Do 445-170 Republic of Korea
| | - Jong Wan Kim
- Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40, Sukwoo-Dong, Hwaseong-Si, Gyeonggi-Do, 445-170, Republic of Korea.
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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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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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Han L, Song X, Yu B, Zhou M, Zhang L, Sun G. Safety evaluation of preoperative stent insertion and clinical analysis on comparison of outcomes between preoperative stent insertion and emergency surgery in the treatment of obstructive left-sided colorectal cancer. Pak J Med Sci 2020; 36:376-381. [PMID: 32292437 PMCID: PMC7150377 DOI: 10.12669/pjms.36.3.1707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective To evaluate the safety of preoperative stent insertion and compare the short- and long-term outcomes between preoperative stent insertion and emergency surgery in the treatment of obstructive left-sided colorectal cancer. Methods The clinical data of 302 patients who underwent surgery for obstructive left-sided colorectal cancer from January 2009 to May 2014 were retrospectively analyzed. They were divided into two groups according to whether to receive stenting for the success rate and complications of stent insertion in colonic lumen by colonoscope, and the number of cases of primary resection and anastomosis, and short-term complications such as incision infection, anastomotic leakage, spleen tear and abdominal abscess as well as mortality and survival rate during hospitalization were compared. Results The success rate of endoscopic nitinol alloy memorial stent insertion in colonic lumen was 97.62%, and the overall incidence of complications was 14.5%, of which the incidence of serious complications (perforation, stent migration) was 4.76%. The primary anastomosis rate was significantly higher in the stent insertion group (85.71%) than that in the emergency surgery group (36.24%). The overall complication rate in the stent insertion group (14 cases) was significantly lower than that in the emergency surgery group (102 cases). There was no significant difference between survival curves (P>0.05). Conclusion Preoperative stent insertion in colonic lumen by colonoscope for decompression is an ideal auxiliary method in the treatment of obstructive left-sided colorectal cancer, and may increase primary anastomosis rate, avoid neostomy, reduce short-term complications, and improve the long-term survival compared to emergency surgery.
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Affiliation(s)
- Lijiang Han
- Lijiang Han, Department of Anal and Intestinal Surgery, Shaoxing Second Hospital, No. 141 Yan'an Road, Shaoxing 312000, Zhejiang Province, P. R. China
| | - Xinjiang Song
- Xinjiang Song, Department of Anal and Intestinal Surgery, Shaoxing Second Hospital, No. 141 Yan'an Road, Shaoxing 312000, Zhejiang Province, P. R. China
| | - Bin Yu
- Bin Yu, Department of Anal and Intestinal Surgery, Shaoxing Second Hospital, No. 141 Yan'an Road, Shaoxing 312000, Zhejiang Province, P. R. China
| | - Mingliang Zhou
- Mingliang Zhou, Department of Anal and Intestinal Surgery, Shaoxing Second Hospital, No. 141 Yan'an Road, Shaoxing 312000, Zhejiang Province, P. R. China
| | - Liping Zhang
- Liping Zhang, Department of Anal and Intestinal Surgery, Shaoxing Second Hospital, No. 141 Yan'an Road, Shaoxing 312000, Zhejiang Province, P. R. China
| | - Guogang Sun
- Guogang Sun, Department of Anal and Intestinal Surgery, Shaoxing Second Hospital, No. 141 Yan'an Road, Shaoxing 312000, Zhejiang Province, P. R. China
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Chen Y, Fan Z, Zhao L. The role of colonic stents in extracolonic malignant large-bowel obstruction. Gastrointest Endosc 2019; 89:441. [PMID: 30665535 DOI: 10.1016/j.gie.2018.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/12/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Yingtong Chen
- Digestive Endoscopy Department, The First Affiliated Hospital of Nanjing, Medical University, Nanjing, China
| | - Zhining Fan
- Digestive Endoscopy Department, The First Affiliated Hospital of Nanjing, Medical University, Nanjing, China
| | - Lili Zhao
- Digestive Endoscopy Department, The First Affiliated Hospital of Nanjing, Medical University, Nanjing, China
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Rodrigues-Pinto E, Castro R, Marcos P, Macedo G. Double self-expandable metal stent placement in a patient with multifocal colorectal obstruction due to advanced gastric cancer: the importance of fluoroscopy. VideoGIE 2019; 4:81-83. [PMID: 30766950 PMCID: PMC6362429 DOI: 10.1016/j.vgie.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Outcomes of stent insertion and mortality in obstructive stage IV colorectal cancer patients through 10 year duration. Surg Endosc 2018; 33:1225-1234. [PMID: 30167945 DOI: 10.1007/s00464-018-6399-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/20/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Colorectal stents are frequently used in patients with stage IV colorectal cancer with obstruction. However, there are only few studies on changes in outcomes of these patients and on the effect of stents on outcome over a long period of time with ongoing changes in therapeutic strategy, including chemotherapy. METHODS We retrospectively evaluated 353 patients with bowel obstruction in stage IV colorectal cancer who underwent colonic stenting between years 2005 and 2014. The study population was divided into three groups based on time periods: 2005-2008, 2009-2011, and 2012-2014. RESULTS The frequency of colorectal stent insertion procedure increased over the time periods (13.8%, 18.3%, and 20.8%, respectively). There were no changes in success rate and total complication rate. However, the early complication rate in the 3rd period was significantly lower than in the other periods (15.4% vs. 17.1% vs. 7.2%; P = 0.039). In the multivariate analysis, carcinomatosis (hazard ratio, 1.478; 95% confidence interval, 1.016-2.149; P = 0.041) and covered or partial-covered stent (hazard ratio, 1.733; 95% confidence interval, 1.144-2.624; P = 0.009; hazard ratio, 1.988; 95% confidence interval, 1.132-3.493; P = 0.017, respectively) were associated with increased complication rate. Stent-related perforation was an independent risk factor related with increased mortality. Although survival duration increased over time (P = 0.042), the mortality rate was unchanged across the three time periods. CONCLUSIONS Over 10 years, the targeted agent use and survival duration increased, and early complication rate was decreased, without change in late complication rate or mortality rate during the three time periods in patients with obstructive stage IV colorectal cancer and stent insertion.
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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: 25] [Impact Index Per Article: 4.2] [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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Han SJ, Jung Y, Cho YS, Chung IK, Kim JY, Eun JY, Lee SH, Ko GB, Lee TH, Park SH, Cho HD, Kim SJ. Clinical Effectiveness of Submucosal Injection with Indigo Carmine Mixed Solution for Colon Endoscopic Mucosal Resection. Dig Dis Sci 2018; 63:775-780. [PMID: 29383606 DOI: 10.1007/s10620-018-4918-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/06/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIMS Submucosal injection with indigo carmine mixed solution can improve the delineation of colorectal neoplasia during endoscopic mucosal resection (EMR). Thus, the aim of this study was to evaluate the efficacy of submucosal injection with indigo carmine mixed solution during EMR of colorectal neoplasia. METHODS This was a prospective, randomized, controlled study of a total of 212 neoplastic colon polyps (5-20 mm) subjected to EMR in a single tertiary university hospital. The patients were randomized into two groups according to whether or not indigo carmine mixed solution was used, and the complete resection rate (CRR) after EMR was evaluated. RESULTS A total of 212 neoplastic polyps (normal saline group, 115; indigo carmine group, 97) were successfully removed by EMR. There was no significant difference in the CRR (92.8 vs. 89.6%, p = 0.414) or macroscopic delineation (86.0 vs. 93.8%, p = 0.118) between the two groups. In a separate analysis of sessile serrated adenomas/polyps (SSAs/Ps), macroscopic delineation was better in the indigo carmine group than the normal saline group (87.5 vs. 53.8%), albeit not significantly (p = 0.103). In univariate analyses, the CRR was significantly related to polyp location, polyp morphology, macroscopic delineation, and pathologic findings. In a multiple logistic regression analysis, macroscopic delineation (odds ratio (OR), 7.616, p = 0.001) and polyp pathology (OR, 8.621; p < 0.001) were significantly associated with the CRR. CONCLUSIONS Submucosal injection with indigo carmine mixed solution did not improve the CRR or macroscopic delineation of EMR of colorectal neoplasias.
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Affiliation(s)
- Su Jung Han
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Bongmyung-Dong, Cheonan, Choongnam, 330-721, Republic of Korea
| | - Yunho Jung
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Bongmyung-Dong, Cheonan, Choongnam, 330-721, Republic of Korea.
| | - Young Sin Cho
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Bongmyung-Dong, Cheonan, Choongnam, 330-721, Republic of Korea
| | - Il-Kwun Chung
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Bongmyung-Dong, Cheonan, Choongnam, 330-721, Republic of Korea
| | - Jae Yun Kim
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Bongmyung-Dong, Cheonan, Choongnam, 330-721, Republic of Korea
| | - Jun Young Eun
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Bongmyung-Dong, Cheonan, Choongnam, 330-721, Republic of Korea
| | - Seoung Ho Lee
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Bongmyung-Dong, Cheonan, Choongnam, 330-721, Republic of Korea
| | - Gyu Bong Ko
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Bongmyung-Dong, Cheonan, Choongnam, 330-721, Republic of Korea
| | - Tae Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Bongmyung-Dong, Cheonan, Choongnam, 330-721, Republic of Korea
| | - Sang Hum Park
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Bongmyung-Dong, Cheonan, Choongnam, 330-721, Republic of Korea
| | - Hyun Deuk Cho
- Department of Pathology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
| | - Sun-Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Bongmyung-Dong, Cheonan, Choongnam, 330-721, Republic of Korea
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Comparison of through-the-scope stent insertion with standard stent insertion for the management of malignant colorectal obstruction: a prospective study. Tech Coloproctol 2016; 20:707-14. [DOI: 10.1007/s10151-016-1527-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/26/2016] [Indexed: 01/12/2023]
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Okafor PN, Stobaugh DJ, Wong Kee Song LM, Limburg PJ, Talwalkar JA. Socioeconomic Inequalities in the Utilization of Colorectal Stents for the Treatment of Malignant Bowel Obstruction. Dig Dis Sci 2016; 61:1669-76. [PMID: 26738737 DOI: 10.1007/s10620-015-4019-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 12/20/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Colorectal stents are increasingly employed as a bridge to surgery or for palliative relief of malignant large bowel obstruction. AIM To explore determinants of inpatient colorectal stent utilization (CRSU). METHODS An analysis of the 2012 National Inpatient Sample was performed. International Classification of Diseases, 9th revision, codes were used to identify discharges associated with CRSU and patient/hospital factors for inclusion in a logistic regression model. RESULTS We identified 217,055 inpatient colonoscopies, approximating 1.1 million inpatient colonoscopies nationwide. Colorectal stents were placed in 1.4 % of all procedures. Across all racial groups, Medicare was the most common payer. Patients with commercial insurance had lower CRSU compared with Medicare patients [adjusted odds ratio (OR) 0.83, 95 % confidence interval (CI) 0.75-0.92]. No gender disparities were identified (OR 0.96, 95 % CI 0.89-1.03). In addition, no racial differences in CRSU existed between Caucasians versus African-Americans (OR 0.94, 95 % CI 0.83-1.06) and Caucasians versus Hispanics (OR 0.96, 95 % CI 0.83-1.1). Compared with patients living in less affluent neighborhoods, those residing in more affluent areas had higher CRSU (OR 1.65, 95 % CI 1.46-1.86). This displayed a linear relationship with the odds of CRSU increasing as household income increased. Less affluent patients also had the highest total charges and longest wait time to CRSU. CRSU was highest among patients treated in larger medical centers (OR 1.7, 95 % CI 1.51-1.93) and teaching hospitals (OR 3.9, 95 % CI 3.2-4.8). CONCLUSION Individuals from less affluent neighborhoods have lower colorectal stent utilization. This disparity is independent of race and likely related to poorer access to healthcare resources.
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Affiliation(s)
- Philip N Okafor
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Derrick J Stobaugh
- North Shore University Health System, 4901 Searle Pkwy, Skokie, IL, 60077, USA
| | - Louis M Wong Kee Song
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Paul J Limburg
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jayant A Talwalkar
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Li BM, Zhu X, Shu X, Liao WD, Zhu Y, Chen YX, Zhou XD, Lv NH, Chen HM, Wang AJ. Value of endoscopic intestinal stent placement in treatment of colorectal cancer complicated with intestinal obstruction. Shijie Huaren Xiaohua Zazhi 2016; 24:1113-1116. [DOI: 10.11569/wcjd.v24.i7.1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the safety, efficacy and value of endoscopic intestinal stent placement in the treatment of colorectal cancer complicated with acute intestinal obstruction.
METHODS: A total of 263 patients with colorectal cancer complicated with intestinal obstruction treated at our hospital from January 2010 to December 2014 were included. Stenting treatment was performed under endoscopy and (or) X-ray. The rate of success, the incidence of postoperative complications, the rate of symptom remission, the rate of surgical excision and other indicators were evaluated.
RESULTS: Stent implantation was successful in 258 (98.1%) cases. The rates of adverse events were: perforation, 1.1% (3 cases); hemorrhage, 3.8% (10 cases); fever, 4.6% (12 cases), and others such as stent dislocation and migration, 3.0% (8 cases). The rates of symptom remission were: abdominal pain, 97.3% (256 cases); abdominal distension, 97.3% (258 cases); and anal dysfunction, 98.1% (258 cases). The rates of surgical resection were: 60 cases for palliative treatment, 198 cases for surgical resection 5-13 d after stent implantation after intestinal preparation, and 143 cases for removal of the tumor by one-stage operation.
CONCLUSION: The symptoms of intestinal obstruction can be relieved by endoscopic intestinal stenting. Emergency endoscopic stenting can be used as a bridge treatment before operation, and it can turn emergency operation to elective surgery, turn two-stage operation to one-stage operation, reduce the difficulty and risk of operation for clinicians, reduce the incidence of postoperative complications, relieve pain, and improve survival quality.
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Cetinkaya E, Dogrul AB, Tirnaksiz MB. Role of self expandable stents in management of colorectal cancers. World J Gastrointest Oncol 2016; 8:113-120. [PMID: 26798442 PMCID: PMC4714140 DOI: 10.4251/wjgo.v8.i1.113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/01/2015] [Accepted: 11/11/2015] [Indexed: 02/05/2023] Open
Abstract
Acute malignant colorectal obstruction is a complication of colorectal cancer that can occur in 7%-29% of patients. Self-expanding metallic stent placement for malignant colorectal obstruction has gained popularity as a safe and effective procedure for relieving obstruction. This technique can be used in the palliation of malignant colorectal obstruction, as a bridge to elective surgery for resectable colorectal cancers, palliation of extracolonic malignant obstruction, and for nonmalignant etiologies such as anastomotic strictures, Crohn’s disease, radiation therapy, and diverticular diseases. Self-expanding metallic stent has its own advantages and disadvantages over the surgery in these indications. During the insertion of the self-expanding metallic stent, and in the follow-up, short term and long term morbidities should be kept in mind. The most important complications of the stents are perforation, stent obstruction, stent migration, and bleeding. Additionally, given the high risk of perforation, if a patient is treated or being considered fortreatmentwith antiangiogenic agents such as bevacizumab, it is not recommended to use self-expanding metallic stent as a palliative treatment for obstruction. Therefore, there is a need for careful clinical evaluation for each patient who is a candidate for this procedure. The purpose of this review was to evaluate self-expanding metallic stent in the management of the obstruction of the colon due to the colorectal and extracolonic obstruction.
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Abstract
A self-expandable metal stent (SEMS) is an effective and safe method for the decompression of colon obstruction. Based on recent evidence, colorectal SEMS is now recommended for the palliation of patients with colonic obstruction from incurable colorectal cancer or extracolonic malignancy and also as a bridge to surgery in those who are a high surgical risk. Prophylactic SEMS insertion in patients with no obstruction symptoms is not recommended. Most colorectal SEMS are inserted endoscopically under fluoroscopic guidance. The technical and clinical success rates of colorectal SEMS are high, and the complication rate is acceptable. Advances in this technology will make the insertion of colorectal SEMS better and may expand the indications of colorectal SEMS in the future.
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Affiliation(s)
- Jeong-Mi Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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20
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Lee HJ, Park SJ, Cheon JH, Kim TI, Kim WH, Hong SP. What is the necessity of endoscopist for successful endoscopic stenting in patients with malignant colorectal obstruction? Int J Colorectal Dis 2015; 30:119-25. [PMID: 25376335 DOI: 10.1007/s00384-014-2060-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Recently, self-expandable metal stents (SEMSs) have been widely used as an initial therapy for relieving malignant colorectal obstructions. However, several factors, including the endoscopist's experience, affect the clinical outcome of SEMSs. The aim of this study was to define the adequate level of experience necessary to perform endoscopic stenting effectively and safely and to identify technical factors for successful stenting. METHODS Between March 2009 and June 2012, 160 patients underwent SEMS placement for malignant colorectal obstruction with the intent of palliation or as a bridge to surgery by a single endoscopist who experienced colonoscopy and endoscopic retrograde cholangiopancreatography. RESULTS The overall technical and clinical success rates were 86.9 and 86.4%, respectively, and 18 complications (11.3%) were observed. There were no differences in any of the clinical outcomes between the consecutive blocks; however, the procedure time decreased significantly after the first 30 procedures (17.4, 16.9, 13.5, and 12.8 min; P = 0.044). American Society of Anesthesiologists (ASA) class, history of a previous operation, proximal colon obstruction, obstruction caused by an extracolonic malignancy, and palliative SEMS placement were associated with technical failure. CONCLUSIONS An endoscopist who experiences a colonoscopy and fluoroscopy performs SEMS placement successfully regardless of the level of experience. After the first 30 procedures, a SEMS insertion could be safely and effectively performed with short procedure time in patients with malignant colorectal obstruction.
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Affiliation(s)
- Hyun Jung Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yensei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
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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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Shariat-Madar B, Jayakrishnan TT, Gamblin TC, Turaga KK. Surgical management of bowel obstruction in patients with peritoneal carcinomatosis. J Surg Oncol 2014; 110:666-9. [PMID: 24986323 DOI: 10.1002/jso.23707] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/03/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND Due to low life expectancy, treatment strategies for malignant bowel obstruction (MBO) due to peritoneal carcinomatosis (PC) emphasize improved quality of life and symptom relief. Currently, the value of palliative surgery to treat obstructive PC is unclear. METHODS A prospectively registered search strategy (PROSPERO) was utilized to identify articles examining outcomes of patients undergoing surgical palliation for MBO from PC in PubMed (2003-2013). Primary outcomes of interest were median overall survival (OS) and treatment complications. RESULTS Of 730 articles screened, 64 were selected for full-text review and 5 were quantitatively synthesized. This comprised 313 patients with MBO, of which 249 (79.5%) presented with PC. The mean age was 61.4 years (range 51-67). The OS for surgical patients was 6.4 months (2.8-19.7, n = 190). Stratification by surgical technique suggested an OS of resection, ostomy, and enteral bypass as 7.2 months (n = 174), 3.4 months (n = 9), and 2.7 months (n = 7), respectively. Major complications occurred in 37.0% of patients that underwent resection. CONCLUSIONS This study supports surgical resection over surgical bypass to treat obstructive PC, as it offered better OS with fewer complications. Higher quality studies are needed to conclusively assess the role of surgery in patients with obstructive PC.
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Affiliation(s)
- Bahbak Shariat-Madar
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Zhao XD, Cai BB, Cao RS, Shi RH. Palliative treatment for incurable malignant colorectal obstructions: A meta-analysis. World J Gastroenterol 2013; 19:5565-5574. [PMID: 24023502 PMCID: PMC3761112 DOI: 10.3748/wjg.v19.i33.5565] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 07/05/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To perform a meta-analysis of palliative stent placement vs palliative surgical decompression for management of incurable malignant colorectal obstructions.
METHODS: The databases of Medline, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials were searched from their inception to July 2012 for studies (prospective, retrospective, randomized controlled trials, and case-control trials) designed as comparative analyses of patients with incurable malignant colorectal obstructions treated by self-expanding metallic stents (SEMS) or palliative surgery. No language restrictions were imposed. The main outcome measures were hospital stay, intensive care unit admission, clinical success rate, 30-d mortality, stoma formation, complications, and overall survival time. The data extraction was conducted by two investigators working independently and using a standardized form. The Mantel-Haenszel χ2 method was used to estimate the pooled risk ratios with 95%CI under a fixed-effects model; when statistical heterogeneity existed in the pooled data (as evaluated by Q test and I2 statistics, where P < 0.10 and I2 < 25% indicated heterogeneity), a random-effects model was used.
RESULTS: Thirteen relevant articles, representing 837 patients (SEMS group, n = 404; surgery group, n = 433), were selected for analysis. Compared to the surgery group, the SEMS group showed lower clinical success (99.8% vs 93.1%, P = 0.0009) but shorter durations of hospital stay (18.84 d vs 9.55 d, P < 0.00001) and time to initiation of chemotherapy (33.36 d vs 15.53 d, P < 0.00001), and lower rate of stoma formation (54.0% vs 12.7%, P < 0.00001). Additionally, the SEMS group experienced a significantly lower rate of 30-d mortality (4.2% vs 10.5%, P = 0.01). Stent-related complications were not uncommon and included perforation (10.1%), migration (9.2%), and occlusion (18.3%). Surgery-related complications were slightly less common and included wound infection (5.0%) and anastomotic leak (4.7%). The rate of total complications was similar between these two groups (SEMS: 34.0% vs surgery: 38.1%, P = 0.60), but the surgery-related complications occurred earlier than stent-related complications (rate of early complications: 33.7% vs 13.7%, P = 0.03; rate of late complications: 32.3% vs 12.7%, P < 0.0001). The overall survival time of SEMS- and surgery-treated patients was not significantly different (7.64 mo vs 7.88 mo).
CONCLUSION: SEMS is less effective than surgery for palliation of incurable malignant colorectal obstructions, but is associated with a shorter time to chemotherapy and lower 30-d mortality.
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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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Abstract
<b><i>Hintergrund: </i></b>Die Implantation von selbstexpandierenden Metallstents (SEMS) in das Kolorektum – insbesondere als «bridge to surgery» – hat sich zunehmend etabliert, obwohl die Charakteristika des Kolons eine Prothesenimplantation erschweren und bisher noch keine optimalen Stents für diese Lokalisation verfügbar sind. Mit einem Stent lässt sich beim Kolonileus sehr patientenschonend eine sofortige Dekompression des Darms herbeiführen und die sonst notwendige Notfalloperation mit hoher Letalität und Komplikationsrate vermeiden. <b><i>Methode: </i></b>Literaturübersicht. <b><i>Ergebnisse: </i></b>Trotz zahlreicher positiver Studienergebnisse («... Stenting ist sehr effektiv, sicher und komplikationsarm im Vergleich zur Operation ...») ergibt eine kritische Analyse der Publikationen aufgrund vieler Faktoren (Patientenselektion, Stenttyp, Implantationsmethode usw.) jedoch eine hohe Heterogenität. <b><i>Schlussfolgerungen: </i></b>Um gute Resultate zu erzielen, sollte eine Stentimplantation ins Kolon nur nach strenger Indikationsstellung von einem erfahrenen Endoskopiker durchgeführt werden. Dabei ist auch die mögliche Alternative einer endoskopisch eingelegten Dekompressionssonde zu prüfen; ebenso sind onkologische Gesichtspunkte (chirurgische Resektion als einziger kurativer Ansatz) zu beachten.
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