Skip to main content

Advertisement

SpringerLink
Log in

Clinical outcomes and patency of self-expanding metal stents in patients with malignant colorectal obstruction: a prospective single center study

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Backgrounds and aims

Self-expanding metal stents (SEMS) have been used as a palliative treatment for malignant colorectal obstruction. However, the reports about primary stent patency rate and associated factors have been limited. This study was performed to evaluate clinical outcomes and factors associated with long-term complications and patency of SEMS in patients with malignant colorectal obstruction.

Materials and methods

Patients who underwent palliative endoscopic placement with uncovered SEMS for a malignant colorectal obstruction were prospectively enrolled at Seoul National University Hospital between April 2005 and August 2007.

Results

Forty-nine patients underwent 51 SEMS placements. Obstruction sites were rectum in 15 patients (30.6%), descending or sigmoid colon in 25 (51.0%), and transverse colon in nine (18.4%), respectively. The causes of obstruction were colorectal cancer in 36 patients (73.5%), direct invasion of gastric cancer in seven (14.3%) and others in six (12.2%). Technical success was achieved in 100% and clinical success in 86%, and there was one procedure-related perforation. Re-obstruction and migration occurred in 16% and 6%, respectively, during mean follow-up period of 331 days. Median stent patency duration was 204 days, and patency rates at 30, 90, and 180 days were 91.2%, 81.0%, and 53.3%, respectively, which was not associated with patient demographics, site of obstruction, or palliative chemotherapy.

Conclusion

Endoscopic SEMS placement is a safe and effective palliative treatment for malignant colorectal obstruction, and overall long-term complication and patency were favorable irrespective of the palliative chemotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Khot UP, Lang AW, Murali K, Parker MC (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89:1096–1102

    Article  PubMed  CAS  Google Scholar 

  2. Bhardwaj R, Parker MC (2003) Palliative therapy of colorectal carcinoma: Stent or surgery? Colorectal Dis 5:518–521

    Article  PubMed  CAS  Google Scholar 

  3. Karadag A, Mentes BB, Uner A, Irkorucu O, Ayaz S, Ozkan S (2003) Impact of stomatherapy on quality of life in patients with permanent colostomies or ileostomies. Int J Colorectal Dis 18:234–238

    PubMed  Google Scholar 

  4. Baron TH (2001) Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 344:1681–1687

    Article  PubMed  CAS  Google Scholar 

  5. Dohmoto M (1991) New method: Endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Dig 3:1507–1512

    Google Scholar 

  6. Baron TH (2005) Colonic stenting: Technique, technology, and outcomes for malignant and benign disease. Gastrointest Endosc Clin N Am 15:757–771

    Article  PubMed  Google Scholar 

  7. Garcia-Cano J, Gonzalez-Huix F, Juzgado D et al (2006) Use of self-expanding metal stents to treat malignant colorectal obstruction in general endoscopic practice (with videos). Gastrointest Endosc 64:914–920

    Article  PubMed  Google Scholar 

  8. Soto S, Lopez-Roses L, Gonzalez-Ramirez A, Lancho A, Santos A, Olivencia P (2006) Endoscopic treatment of acute colorectal obstruction with self-expandable metallic stents: experience in a community hospital. Surg Endosc 20:1072–1076

    Article  PubMed  CAS  Google Scholar 

  9. 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 99:2051–2057

    Article  PubMed  Google Scholar 

  10. 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 246:24–30

    Article  PubMed  Google Scholar 

  11. Jost RS, Jost R, Schoch E, Brunner B, Decurtins M, Zollikofer CL (2007) Colorectal stenting: An effective therapy for preoperative and palliative treatment. Cardiovasc Intervent Radiol 30:433–440

    Article  PubMed  Google Scholar 

  12. Baron TH, Rey JF, Spinelli P (2002) Expandable metal stent placement for malignant colorectal obstruction. Endoscopy 34:823–830

    Article  PubMed  CAS  Google Scholar 

  13. Deans GT, Krukowski ZH, Irwin ST (1994) Malignant obstruction of the left colon. Br J Surg 81:1270–1276

    Article  PubMed  CAS  Google Scholar 

  14. Umpleby HC, Williamson RC (1984) Survival in acute obstructing colorectal carcinoma. Dis Colon Rectum 27:299–304

    Article  PubMed  CAS  Google Scholar 

  15. Fielding LP, Phillips RK, Hittinger R (1989) Factors influencing mortality after curative resection for large bowel cancer in elderly patients. Lancet 1:595–597

    Article  PubMed  CAS  Google Scholar 

  16. Pothuri B, Guirguis A, Gerdes H, Barakat RR, Chi DS (2004) The use of colorectal stents for palliation of large-bowel obstruction due to recurrent gynecologic cancer. Gynecol Oncol 95:513–517

    Article  PubMed  Google Scholar 

  17. Vitale MA, Villotti G, d'Alba L, Frontespezi S, Iacopini F, Iacopini G (2006) Preoperative colonoscopy after self-expandable metallic stent placement in patients with acute neoplastic colon obstruction. Gastrointest Endosc 63:814–819

    Article  PubMed  Google Scholar 

  18. Mucci-Hennekinne S, Kervegant AG, Regenet N et al (2007) Management of acute malignant large-bowel obstruction with self-expanding metal stent. Surg Endosc 21:1101–1103

    Article  PubMed  CAS  Google Scholar 

  19. Ptok H, Marusch F, Steinert R, Meyer L, Lippert H, Gastinger I (2006) Incurable stenosing colorectal carcinoma: endoscopic stent implantation or palliative surgery? World J Surg 30:1481–1487

    Article  PubMed  Google Scholar 

  20. Tilney HS, Lovegrove RE, Purkayastha S et al (2007) Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 21:225–233

    Article  PubMed  CAS  Google Scholar 

  21. Lee KM, Shin SJ, Hwang JC et al (2007) Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction. Gastrointest Endosc 66:931–936

    Article  PubMed  Google Scholar 

  22. Choi JS, Choo SW, Park KB et al (2007) Interventional management of malignant colorectal obstruction: Use of covered and uncovered stents. Korean J Radiol 8:57–63

    Article  PubMed  Google Scholar 

  23. Telford JJ, Carr-Locke DL, Baron TH et al (2004) Palliation of patients with malignant gastric outlet obstruction with the enteral wallstent: outcomes from a multicenter study. Gastrointest Endosc 60:916–920

    Article  PubMed  Google Scholar 

  24. Ptok H, Meyer F, Marusch F et al (2006) Palliative stent implantation in the treatment of malignant colorectal obstruction. Surg Endosc 20:909–914

    Article  PubMed  CAS  Google Scholar 

  25. Tomiki Y, Watanabe T, Ishibiki Y et al (2004) Comparison of stent placement and colostomy as palliative treatment for inoperable malignant colorectal obstruction. Surg Endosc 18:1572–1577

    PubMed  CAS  Google Scholar 

  26. Song HY, Kim JH, Shin JH et al (2007) A dual-design expandable colorectal stent for malignant colorectal obstruction: results of a multicenter study. Endoscopy 39:448–454

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Republic of Korea

    Jong Pil Im, Sang Gyun Kim, Hyoun Woo Kang, Joo Sung Kim, Hyun Chae Jung & In Sung Song

Authors
  1. Jong Pil Im
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sang Gyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyoun Woo Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joo Sung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hyun Chae Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. In Sung Song
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sang Gyun Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Im, J.P., Kim, S.G., Kang, H.W. et al. Clinical outcomes and patency of self-expanding metal stents in patients with malignant colorectal obstruction: a prospective single center study. Int J Colorectal Dis 23, 789–794 (2008). https://doi.org/10.1007/s00384-008-0477-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-008-0477-1

Keywords

Search

Navigation