Large-diameter self-expanding metal stents appear to be safe and effective for malignant colonic obstruction with and without concurrent use of chemotherapy
- 109 Downloads
- 11 Citations
Abstract
Background
Colonic stents are used chiefly for malignant large-bowel obstruction as a palliative measure or bridge to surgery that facilitates one-step resections. Literature on colorectal stenting demonstrates good safety and efficacy; however, a recent trial has raised concerns regarding the safety of a new large-diameter stent, especially in the setting of concurrent chemotherapy. This study evaluated our experience with colorectal stenting using mainly this stent.
Methods
The study was a retrospective chart review with a minimum 6-month telephone follow-up of patients who underwent colorectal stenting for malignant obstruction at Queen’s University between December 2005 and March 2008. The primary outcome was clinical success, defined as full or partial relief of obstructive symptoms or successful bridge to surgery. Clinical failure was defined as persistence or recurrence of obstructive symptoms, death from obstruction, or the need for unplanned surgical intervention.
Results
Thirty patients underwent stenting for malignant obstruction during the study period. The technical success rate was 96.7%. Clinical success was 83% at 30 days and 69% at 6 months. The complication rate was 20%, with four early and two late complications. There were no perforations or stent migrations. Thirty-three percent of patients received chemotherapy with a stent in situ; this was not associated with an increased complication rate. Ninety-one percent of patients and families reported satisfaction with the procedure.
Conclusions
Large-diameter stents appear to be safe for malignant colonic obstruction with and without concurrent chemotherapy and they have similar complication rates as older-generation stents with perhaps lower migration potential.
Keywords
Colorectal cancer Therapeutic/palliation EndoscopyNotes
Disclosures
Ms. Barbara Bielawska, Dr. Lawrence C. Hookey, and Dr. Diederick Jalink have no conflicts of interest or financial ties to disclose.
References
- 1.Dohmoto M (1991) New method—endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Dig 3:1507–1512Google Scholar
- 2.Suzuki N, Saunders BP, Thomas-Gibson S, Akle C, Marshall M, Halligan S (2004) Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Dis Colon Rectum 47:1201–1207CrossRefPubMedGoogle Scholar
- 3.Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ (2007) Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 246:24–30CrossRefPubMedGoogle Scholar
- 4.Small AJ, Baron TH (2008) How safe and effective is a nitinol self-expanding metallic stent for palliation of malignant colonic obstruction? Nat Clin Pract Gastroenterol Hepatol 5:356–357CrossRefPubMedGoogle Scholar
- 5.Kozarek R (2008) Making sense out of colonic stents. Gastrointest Endosc 67:85–87CrossRefPubMedGoogle Scholar
- 6.van Hooft JE, Fockens P, Marinelli AW, Timmer R, van Berkel AM, Bossuyt PM, Bemelman WA (2008) Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy 40:184–191CrossRefPubMedGoogle Scholar
- 7.Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M (2004) Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99:2051–2057CrossRefPubMedGoogle Scholar
- 8.van Hooft JE, Fockens P, Marinelli AW, Bossuyt PM, Bemelman WA (2006) Premature closure of the Dutch stent-in I study. Lancet 368:1573–1574CrossRefPubMedGoogle Scholar
- 9.[No authors listed] (2008) Abstracts from Around the World. Potential hazard of large diameter colonic stent for malignant colonic obstruction. Clin Gastroenterol Hepatol 6:838-839Google Scholar
- 10.Repici A, De Caro G, Luigiano C, Fabbri C, Pagano N, Preatoni P, Danese S, Fuccio L, Consolo P, Malesci A, D’Imperio N, Cennamo V (2008) WallFlex colonic stent placement for management of malignant colonic obstruction: a prospective study at two centers. Gastrointest Endosc 67:77–84CrossRefPubMedGoogle Scholar
- 11.Best L, Simmonds P, Baughan C, Buchanan R, Davis C, Fentiman I, George S, Gosney M, Northover J, Williams C (2000) Collaboration Colorectal Meta-analysis. Palliative chemotherapy for advanced or metastatic colorectal cancer. Cochrane Database Syst Rev (2). Art. no. CD001545. doi: 10.1002/14651858.CD001545
- 12.Mates M, Dudgeon D, Hookey LC, Hurlbut DJ, Belliveau P, Booth CM (2008) Intractable nausea in a patient with metastatic colorectal cancer following insertion of a colonic stent. J Pain Symptom Manage 36:e6–e10CrossRefPubMedGoogle Scholar
- 13.Hapani S, Chu D, Wu S (2009) Risk of gastrointestinal perforation in patients with cancer treated with bevacizumab: a meta-analysis. Lancet Oncol 10:559–568CrossRefPubMedGoogle Scholar
- 14.Cennamo V, Fuccio L, Mutri V, Minardi ME, Eusebi LH, Ceroni L, Laterza L, Ansaloni L, Pinna AD, Salfi N, Martoni AA, Bazzoli F (2009) Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy? Clin Gastroenterol Hepatol 7:1174–1176CrossRefPubMedGoogle Scholar
- 15.Law WL, Choi HK, Lee YM, Chu KW (2004) Palliation for advanced malignant colorectal obstruction by self-expanding metallic stents: prospective evaluation of outcomes. Dis Colon Rectum 47:39–43CrossRefPubMedGoogle Scholar
- 16.Khot UP, Lang AW, Murali K, Parker MC (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89:1096–1102CrossRefPubMedGoogle Scholar