Endoscopic Palliation in Patients With Incurable Malignant Colorectal Obstruction by Means of Self-expanding Metal Stent: Analysis of Results and Predictors of Outcomes in a Large Multicenter Series | Gastroenterology | JAMA Surgery | JAMA Network
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Original Article
Oct 2011

Endoscopic Palliation in Patients With Incurable Malignant Colorectal Obstruction by Means of Self-expanding Metal Stent: Analysis of Results and Predictors of Outcomes in a Large Multicenter Series

Author Affiliations

Author Affiliations: Departments of Gastroenterology, University Hospital L. Sacco, Milano (Drs Manes and Ardizzone), University Hospital S. Orsola, Bologna (Drs Fuccio and Cennamo), Clinical Institute Humanitas, Rozzano, Milano (Drs Repici and Carlino), University Hospital S. Paolo, Milano (Drs Masci and Mangiavillano), and SS Trinità Hospital, Borgomanero (Dr Occhipinti); and Endoscopy Unit, National Cancer Institute and G. Pascale Foundation, Napoli (Drs de Bellis and Rossi), Italy.

Arch Surg. 2011;146(10):1157-1162. doi:10.1001/archsurg.2011.233
Abstract

Objectives To evaluate the short- and long-term efficacy of self-expanding metal stents (SEMSs) in patients with colorectal obstruction and incurable cancer and the related factors that affect outcomes.

Design Retrospective analysis of SEMS placement for incurable colorectal obstruction in a 3-year period.

Setting Five tertiary care endoscopic centers.

Patients and Intervention Consecutive patients (N = 201) undergoing stenting for incurable malignant obstruction.

Main Outcome Measurements Clinical and technical success of stenting, complications rate, and factors affecting outcomes.

Results Technical success was achieved in 184 of 201 patients (91.5%) and clinical success occurred in 165 of 184 patients (89.7%; 82.1% of 201 patients). Technical and clinical failures were more frequent in extrinsic and long colorectal stenoses. Overall, 165 patients had normal bowel movements during follow-up (mean [SD], 115.5 [100.3] days; range, 1-500 days), 15 developed complications, 127 had a functioning SEMS at the time of death, and 23 were alive at completion of the study. Twenty-four (11.9%) major complications occurred: 11 migrations, 12 perforations, and 1 reobstruction. Migration of SEMSs was associated with stent diameter less than 25 mm. Bevacizumab therapy increased the risk of perforation by 19.6-fold. Karnofsky performance status of 50 or less was associated with shorter survival and a 3.7-fold higher risk of death within 6 months after the stent was placed.

Conclusions The use of SEMSs is safe and effective for palliation of incurable malignant colonic obstruction; approximately 75% of patients with SEMSs are able to avoid colostomy.

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