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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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Dillon J, Mills AN, Pawloski KR, Scribetta N, Greenstein A. Arterial-colonic fistula secondary to colonic stent erosion into the left external iliac artery. J Surg Case Rep 2023; 2023:rjac615. [PMID: 36636657 PMCID: PMC9831645 DOI: 10.1093/jscr/rjac615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Self-expandable metal stent (SEMS) are widely utilized as a bridge to surgical intervention and for palliative treatment of malignant bowel obstructions. The risk of complications associated with SEMS is low in well-selected patients. Stent erosion is a rare but serious adverse event that is associated with high morbidity and mortality. Here, we report the case of a 74-year-old patient with a colonic obstruction secondary to a pelvic mass that was treated with SEMS and radiotherapy, who developed a partial thickness stent erosion and recurrent hematochezia 6 years after placement. Endoscopic retrieval was not technically feasible. During attempted surgical resection, massive hemorrhage occurred from a colonic-arterial fistula to the left external iliac artery resulting in death. While SEMS remain an effective, minimally invasive approach for the management of bowel obstructions, prolonged in-situ lifetime may confer an increased risk of serious adverse events including erosion and fistula formation.
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Affiliation(s)
- Jacquelyn Dillon
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexandra N Mills
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kate R Pawloski
- Correspondence address. Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA. Tel: 973-224-3791; E-mail:
| | - Nicholas Scribetta
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander Greenstein
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Lueders A, Ong G, Davis P, Weyerbacher J, Saxe J. Colonic stenting for malignant obstructions-A review of current indications and outcomes. Am J Surg 2022; 224:217-227. [DOI: 10.1016/j.amjsurg.2021.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/08/2021] [Accepted: 12/27/2021] [Indexed: 11/01/2022]
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