Short- and long-term clinical outcomes of self-expandable metal stents inserted for colorectal obstruction and efficacy of different insertion techniques

Gastroenterol Hepatol. 2019 Mar;42(3):157-163. doi: 10.1016/j.gastrohep.2018.07.014. Epub 2018 Oct 9.
[Article in English, Spanish]

Abstract

Objectives: (1) To evaluate the short- and long-term clinical outcomes of patients after colorectal stent placement and (2) to assess the safety and efficacy of the stents for the resolution of colorectal obstruction according to the insertion technique.

Methods: Retrospective cohort study which included 177 patients with colonic obstruction who underwent insertion of a stent.

Results: A total of 196 stents were implanted in 177 patients. Overall, the most common cause of obstruction was colorectal cancer (89.3%). Ninety-two stents (47%) were placed by radiologic technique and 104 (53%) by endoscopy under fluoroscopic guidance. Technical success rates were 95% in both groups. Clinical success rates were 77% in the radiological group and 81% in the endoscopic group (p>0.05). The rate of complications was higher in the radiologic group compared with the endoscopic group (38% vs 20%, respectively; p=0.006). Among patients with colorectal cancer (158), 65 stents were placed for palliation but 30% eventually required surgery. The multivariate analysis identified three factors associated with poorer long-term survival: tumor stage IV, comorbidity and onset of complications.

Conclusions: Stents may be an alternative to emergency surgery in colorectal obstruction, but the clinical outcome depends on the tumor stage, comorbidity and stent complications. The rate of definitive palliative stent placement was high; although surgery was eventually required in 30%. Our study suggests that the endoscopic method of stent placement is safer than the radiologic method.

Keywords: Bridge to surgery; Cancer colorrectal; Colorectal cancer; Colorectal obstruction; Obstrucción colorrectal; Paliación; Palliation; Prótesis metálica autoexpandible; Puente a la cirugía; Self-expandable metal stent.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Aged
  • Colonic Diseases / etiology
  • Colonic Diseases / mortality
  • Colonic Diseases / therapy*
  • Colonoscopy
  • Colorectal Neoplasms / complications
  • Colorectal Neoplasms / mortality
  • Colorectal Neoplasms / pathology
  • Constriction, Pathologic / complications
  • Diverticulitis / complications
  • Female
  • Fluoroscopy
  • Humans
  • Intestinal Obstruction / etiology
  • Intestinal Obstruction / mortality
  • Intestinal Obstruction / therapy*
  • Male
  • Middle Aged
  • Palliative Care / statistics & numerical data
  • Prosthesis Implantation / methods*
  • Prosthesis Implantation / statistics & numerical data
  • Radiography, Interventional
  • Rectal Diseases / etiology
  • Rectal Diseases / mortality
  • Rectal Diseases / therapy*
  • Retrospective Studies
  • Self Expandable Metallic Stents* / statistics & numerical data
  • Treatment Outcome