Takeaki Matsuzawa1, Hideyuki Ishida1, Shuntaro Yoshida2, Hiroyuki Isayama3, Toshio Kuwai4, Iruru Maetani5, Mamoru Shimada6, Tomonori Yamada7, Shuji Saito8, Masafumi Tomita9, Koichi Koizumi10, Nobuto Hirata11, Takashi Sasaki12, Toshiyuki Enomoto13, Yoshihisa Saida13. 1. Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan. 2. Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 3. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 4. Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan. 5. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan. 6. Department of Surgery, Moriguchi Keijinkai Hospital, Osaka, Japan. 7. Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan. 8. Department of Surgery, National Hospital Organization Yokohama Medical Center, Yokohama, Japan. 9. Department of Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan. 10. Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan. 11. Department of Gastroenterology, Kameda Medical Center, Kamogawa, Japan. 12. Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. 13. Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan.
Abstract
BACKGROUND: Endoscopic self-expandable metal stent placement has been used as an alternative to surgery for malignant colorectal obstruction; however, factors affecting its clinical outcome are unclear. OBJECTIVE: To clarify the short-term safety and efficacy of endoscopic self-expandable metal stent placement for malignant colorectal obstruction and to identify factors associated with its clinical and technical failure. DESIGN: Prospective clinical cohort study. SETTING: Fourteen academic centers and 32 community hospitals. PATIENTS: A total of 513 consecutive patients with malignant colorectal obstruction. INTERVENTION: Endoscopic self-expandable metal stent placement, sharing of stent placement methods among participating facilities. MAIN OUTCOME MEASUREMENTS: The primary endpoint was clinical success, defined as symptom and radiological finding resolution within 24 hours. Secondary endpoints were technical success and adverse events. The follow-up period was 7 days. RESULTS: The clinical and technical success rates were 95.5% and 97.9%, respectively. Major adverse events included perforation (2.1%), stent migration (1.0%), and stent occlusion (0.8%). The main causes of perforation were the procedure itself (0.8%) and comorbidities (obstructive colitis and impending perforation) not apparent before stent placement (0.6%). Extrinsic tumor origin was independently associated with the clinical failure after stent placement (odds ratio 4.23; 95% confidence interval, 1.21-14.79; P = .02). Stricture marking trended toward a negative association with technical failure (P = .09). LIMITATIONS: Noncomparative study. CONCLUSION: Strict inclusion criteria and stricture marking may improve the technical and clinical success of stent placement.
BACKGROUND: Endoscopic self-expandable metal stent placement has been used as an alternative to surgery for malignant colorectal obstruction; however, factors affecting its clinical outcome are unclear. OBJECTIVE: To clarify the short-term safety and efficacy of endoscopic self-expandable metal stent placement for malignant colorectal obstruction and to identify factors associated with its clinical and technical failure. DESIGN: Prospective clinical cohort study. SETTING: Fourteen academic centers and 32 community hospitals. PATIENTS: A total of 513 consecutive patients with malignant colorectal obstruction. INTERVENTION: Endoscopic self-expandable metal stent placement, sharing of stent placement methods among participating facilities. MAIN OUTCOME MEASUREMENTS: The primary endpoint was clinical success, defined as symptom and radiological finding resolution within 24 hours. Secondary endpoints were technical success and adverse events. The follow-up period was 7 days. RESULTS: The clinical and technical success rates were 95.5% and 97.9%, respectively. Major adverse events included perforation (2.1%), stent migration (1.0%), and stent occlusion (0.8%). The main causes of perforation were the procedure itself (0.8%) and comorbidities (obstructive colitis and impending perforation) not apparent before stent placement (0.6%). Extrinsic tumor origin was independently associated with the clinical failure after stent placement (odds ratio 4.23; 95% confidence interval, 1.21-14.79; P = .02). Stricture marking trended toward a negative association with technical failure (P = .09). LIMITATIONS: Noncomparative study. CONCLUSION: Strict inclusion criteria and stricture marking may improve the technical and clinical success of stent placement.
Authors: Chi Chung Foo; Samuel Ho Ting Poon; Rosemaire Hon Yiu Chiu; Wai Yiu Lam; Lam Chi Cheung; Wai Lun Law Journal: Surg Endosc Date: 2018-10-19 Impact factor: 4.584
Authors: Mauro Podda; Patricia Sylla; Gianluca Baiocchi; Michel Adamina; Vanni Agnoletti; Ferdinando Agresta; Luca Ansaloni; Alberto Arezzo; Nicola Avenia; Walter Biffl; Antonio Biondi; Simona Bui; Fabio C Campanile; Paolo Carcoforo; Claudia Commisso; Antonio Crucitti; Nicola De'Angelis; Gian Luigi De'Angelis; Massimo De Filippo; Belinda De Simone; Salomone Di Saverio; Giorgio Ercolani; Gustavo P Fraga; Francesco Gabrielli; Federica Gaiani; Mario Guerrieri; Angelo Guttadauro; Yoram Kluger; Ari K Leppaniemi; Andrea Loffredo; Tiziana Meschi; Ernest E Moore; Monica Ortenzi; Francesco Pata; Dario Parini; Adolfo Pisanu; Gilberto Poggioli; Andrea Polistena; Alessandro Puzziello; Fabio Rondelli; Massimo Sartelli; Neil Smart; Michael E Sugrue; Patricia Tejedor; Marco Vacante; Federico Coccolini; Justin Davies; Fausto Catena Journal: World J Emerg Surg Date: 2021-07-02 Impact factor: 5.469