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Predictors of outcome for endoscopic colorectal stenting: a decade experience

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International Journal of Colorectal Disease Aims and scope Submit manuscript

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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References

  1. Bielawska B, Hookey LC, Jalink D (2010) Large-diameter self-expanding metal stents appear to be safe and effective for malignant colonic obstruction with and without concurrent use of chemotherapy. Surg Endosc 24:2814–2821

    Article  PubMed  Google Scholar 

  2. Branger F, Thibaudeau E, Mucci-Hennekinne S, Metivier-Cesbron E, Vychnevskaia K, Hamy A, Arnaud JP (2010) Management of acute malignant large-bowel obstruction with self-expanding metal stent. Int J Color Dis 25:1481–1485

    Article  Google Scholar 

  3. Foo CC, Poon JT, Law WL (2011) Self-expanding metallic stents for acute left-sided large-bowel obstruction: a review of 130 patients. Color Dis 13:549–554

    Article  CAS  Google Scholar 

  4. Mackay CD, Craig W, Hussey JK, Loudon MA (2011) Self-expanding metallic stents for large bowel obstruction. Br J Surg 98:1625–1629

    Article  CAS  PubMed  Google Scholar 

  5. Soren M, Hensler M, Knop FK, West F, Wille-Jorgensen P (2004) Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center. Dis Colon rectum 47:444–450

  6. Karoui M, Charachon A, Delbaldo C, Loriau J, Laurent A, Sobhani I, Van Nhieu JT, Delchier JC, Fagniez PL, Piedbois P, Cherqui D (2007) Stents for palliation of obstructive metastatic colon cancer: impact on management and chemotherapy administration. Arch Surg 142:619–623

    Article  PubMed  Google Scholar 

  7. Tamim WZ, Ghellai A, Counihan TC, Swanson RS, Colby JM, Sweeney WB (2000) Experience with endoluminal colonic wall stents for the management of large bowel obstruction for benign and malignant disease. Arch Surg 135:434–438

    Article  CAS  PubMed  Google Scholar 

  8. Rayhanabad JA, Abbas MA (2009) Long-term outcome of endoscopic stenting for benign and malignant colorectal disorders. Am Surgeon 75:897–900

    PubMed  Google Scholar 

  9. 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 47:1201–1207

  10. Small AJ, Young-Fadok TM, Baron TH (2008) Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases. Surg Endosc 22:454–462

    Article  CAS  PubMed  Google Scholar 

  11. Abbas MA (2009) Endoscopic management of acute colorectal anastomotic complications using temporary stent. JSLS 13:420–424

    PubMed  PubMed Central  Google Scholar 

  12. Abbas MA, Falls GN (2008) Endoscopic stenting of colovaginal fistula: the transanal and transvaginal “kissing” wire technique. JSLS 12:88–92

    PubMed  PubMed Central  Google Scholar 

  13. Forshaw MJ, Sankararajah D, Stewart M, Parker MC (2005) Self-expanding metallic stents in the treatment of benign colorectal disease: indications and outcomes. Color Dis 8:102–111

    Article  Google Scholar 

  14. Paul L, Pinto I, Gomez H, Fernandez-Lobato R, Moyano E (2002) Metallic stents in the treatment of benign diseases of the colon: preliminary experience in 10 cases. Radiology 223:715–722

    Article  PubMed  Google Scholar 

  15. Carne PW, Fryne JN, Robertson GM, Frizelle F (2004) Stents or open operation for palliation of colorectal cancer: a retrospective, cohort study of perioperative outcome and long-term survival. Dis Colon rectum 47:1455–1461

  16. Law WL, Choi HK, Chu KW (2003) Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg 90:1429–1433

    Article  CAS  PubMed  Google Scholar 

  17. Tilney HS, Lovegrove RE, Purkayastha S, Sains PS, Weston-Petrides GK, Darzi AW, Tekkis PP, Heriot AG (2007) Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 21:225–233

    Article  CAS  PubMed  Google Scholar 

  18. Pirlet IA, Slim K, Kwiatkowski F, Michot F, Millat BL (2011) Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc 25:1814–1821

    Article  PubMed  Google Scholar 

  19. De Gregorio MA, Mainar A, Tejero E, Tobio R, Alfonso E, Pinto I, Fernandez R, Herrera M, Fernandez JA (1998) Acute colorectal obstruction: stent placement for palliative treatment—results of a multicenter study. Radiology 209:117–120

    Article  CAS  PubMed  Google Scholar 

  20. Repici A, Fregonese D, Costamagna G, Dumas R, Kahler G, Meisner S, Giovannini M, Freema J, Petruziello L, Hervoso C, Comunale S, Faroux R (2007) Ultraflex prevision colonic stent placement for palliation of malignant colonic obstruction: a prospective multicenter study. Gastrointest Endosc 66:920–927

    Article  PubMed  Google Scholar 

  21. Brehant O, Fuks D, Bartoli E, Yzet T, Verhaeghe P, Regimbeau JM (2009) Elective (planned) colectomy in patients with colorectal obstruction after placement of a self-expanding metallic stent as a bridge to surgery: the results of a prospective study. Color Dis 11:178–183

    Article  CAS  Google Scholar 

  22. Fregonese D, Naspetti R, Ferrer S, Gallego J, Costamagna G, Dumas R, Campaioli M, Morante AL, Mambrini P, Meisner S, Repici A, Andreo L, Enzo M, Mingo A, Barcenilla J, Petruzziello L (2008) Ultraflex precision colonic stent placement as a bridge to surgery in patients with malignant colon obstruction. Gastrointest Endosc 67:68–73

    Article  PubMed  Google Scholar 

  23. Iversen LH, Kratmann M, Boje M, Laurberg S (2011) Self-expanding metallic stents as bridge to surgery in obstructing colorectal cancer. Br J Surg 98:275–281

    Article  CAS  PubMed  Google Scholar 

  24. Jimenez-Perez J, Casellas J, Garcia-Cano J, Vandervoort J, Garcia-Escribano OR, Barcenilla J, Delgado AA, Goldberg P, Gonzalez-Huiz F, Vazquez-Astray E, Meisner S (2011) Colonic stenting as a bridge to surgery in malignant large-bowel obstruction: a report from two large multinational registries. Am J Gastroenterol 106:2174–2180

    Article  CAS  PubMed  Google Scholar 

  25. Lee JH, Ross WA, Davila R, Chang G, Lin E, Dekovich A, Davila M (2010) Self-expandable metal stents (SEMS) can serve as a bridge to surgery or as a definitive therapy in patients with an advanced stage of cancer: clinical experience of a tertiary cancer center. Dig Dis Sci 55:3530–3536

    Article  CAS  PubMed  Google Scholar 

  26. Lee HJ, Park SJ, Min BS, Cheon JH, Kim TI, Kim NK, Kim WH, Hong SP (2014) The role of primary colectomy after successful endoscopic stenting in patients with obstructive metastatic colorectal cancer. Dis Colon rectum 57:694–699

  27. Ng K, Law WL, Lee YM, Choi HK, Seto CH, Ho JW (2006) Self-expanding metallic stent as a bridge to surgery versus emergency resection for obstructing left-sided colorectal cancer: a case-matched study. J Gastrointest Surg 10:798–803

    Article  PubMed  Google Scholar 

  28. Li YD, Cheng YS, Li MH, Fan YB, Chen NW, Wang Y, Zhao JG (2010) Management of acute malignant colorectal obstruction with a novel self-expanding metallic stent as a bridge to surgery. Eur J Radiol 73:566–571

    Article  PubMed  Google Scholar 

  29. Fernandez-Esparrach G, Bordas JM, Giraldez MD, Gines A, Pellise M, Sendino O, Martinez-Palli G, Castells A, Llach J (2010) Severe complications limit long-term clinical success of self-expanding metal stents in patients with obstructive colorectal cancer. Am J Gastroenterol 105:1087–1093

    Article  PubMed  Google Scholar 

  30. 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  CAS  PubMed  Google Scholar 

  31. Saida Y, Sumiyama Y, Nagao J, Uramatsu M (2003) Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon rectum 46:S44–S49

  32. 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 

  33. Small AJ, Coelho-Prabhu N, Baron TH (2010) Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc 71:560–572

    Article  PubMed  Google Scholar 

  34. Xinopoulous D, Dimitroulopoulos D, Theodosopoulos T, Tsamakidis K, Bitsakou G, Plataniotis G, Gontikakis M, Kontis M, Paraskevas I, Vassilobpoulos P, Paraskevas E (2004) Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Surg Endosc 18:421–426

    Article  Google Scholar 

  35. Shin SJ, Kim TI, Kim BC, Lee YC, Song SY, Kim WH (2008) Clinical application of self-expandable metallic stent for treatment of colorectal obstruction caused by extrinsic invasive tumors. Dis Colon rectum 51:578–583

  36. Saida Y, Enomoto T, Takabyashi K, Otsuji A, Nakamura Y, Nagao J, Kusachi S (2011) Outcome of 141 cases of self-expandable metallic stent placements for malignant and benign colorectal strictures in a single center. Surg Endosc 25:1748–1752

    Article  PubMed  Google Scholar 

  37. Jung MK, Park SY, Jeon SW, Cho CM, Tak WY, Kweon YO, Kim SK, Choi YH, Kim GC, Ryeom HK (2010) Factors associated with the long-term outcome of a self-expandable colon stent used for palliation of malignant colorectal obstruction. Surg Endosc 24:525–530

    Article  PubMed  Google Scholar 

  38. Small AJ, Baron TH (2008) Comparison of wall stent and ultraflex stents for palliation of malignant left-sided colon obstruction: a retrospective, case-matched analysis. Gastrointest Endosc 67:478–488

    Article  PubMed  Google Scholar 

  39. Boyle DJ, Thorn C, Saini A, Elton C, Atkin GK, Mitchell IC, Lotzof MA, Mathur P (2015) Predictive factors for successful colonic stenting in acute large-bowel obstruction: a 15-year cohort analysis. Dis Colon rectum 58:358–362

  40. Moon CM, Kim TI, Lee MS, Ko BM, Kim HS, Lee KM, Byeon JS, Kim YS (2010) Comparison of a newly designed double-layered combination covered stent and D-weave uncovered stent for decompression of obstructive colorectal cancer: a prospective multicenter study. Dis Colon rectum 53:1190–1196

  41. Lee KM, Shin SJ, Hwang JC, Cheong JY, Yoo BM, Lee KJ, Hahm KB, Kim JH, Cho SW (2007) Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction. Gastrointest Endosc 66:931–936

    Article  PubMed  Google Scholar 

  42. Meisner S, Hensler M, Knop FK, West F, Wille-Jorgensen P (2004) Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center. Dis Colon rectum 47:444–450

  43. Choi JH, Lee YJ, Kim ES, Choi JH, Cho KB, Park KS, Jang BK, Chung WJ, Hwang JS (2013) Covered self-expandable metal stents are more associated with complications in the management of malignant colorectal obstruction. Surg Endosc 27:3220–3227

    Article  PubMed  Google Scholar 

  44. Caceres A, Zhou Q, Iasonos A, Gerdes H, Chi DS, Barakat RR (2008) Colorectal stents for palliation of large-bowel obstructions in recurrent gynecologic cancer: an updated series. Gynecol Oncol 108:482–485

    Article  PubMed  Google Scholar 

  45. Keranen I, Lepisto A, Udd M, Halttunen J, Kylanpaa L (2012) Stenting for malignant colorectal obstruction: a single-center experience with 101 patients. Surg Endosc 26:423–430

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cleveland Clinic Abu Dhabi, Digestive Disease Institute, Al-Maryah Island, P.O. Box 112412, Abu Dhabi, UAE

    Maher A. Abbas

  2. Cleveland Clinic, Digestive Disease Institute, Cleveland, OH, USA

    Maher A. Abbas & Mohammad A. Abbass

  3. University of California, San Diego, CA, USA

    Greg Kharabadze

  4. Kaiser Permanente, Los Angeles, CA, USA

    Ethan M. Ross

Authors
  1. Maher A. Abbas
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  2. Greg Kharabadze
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  4. Mohammad A. Abbass
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Correspondence to Maher A. Abbas.

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Additional information

Delivered as a podium presentation at the American Society of Colon and Rectal Surgeons Annual Meeting, Boston, Massachusetts, May 30–June 3, 2015

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Abbas, M.A., Kharabadze, G., Ross, E.M. et al. Predictors of outcome for endoscopic colorectal stenting: a decade experience. Int J Colorectal Dis 32, 375–382 (2017). https://doi.org/10.1007/s00384-016-2696-1

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