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

Gianpiero Manes, Mario De Bellis, Lorenzo Fuccio, Alessandro Repici, Enzo Masci, Sandro Ardizzone, Benedetto Mangiavillano, Alessandra Carlino, Giovanni Battista Rossi, Pietro Occhipinti, Vincenzo Cennamo

Research output: Contribution to journalArticle

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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). Technicaland 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.

Original languageEnglish
Pages (from-to)1157-1162
Number of pages6
JournalArchives of Surgery
Volume146
Issue number10
DOIs
Publication statusPublished - Oct 2011

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Stents
Metals
Karnofsky Performance Status
Colostomy
Tertiary Care Centers
Pathologic Constriction
Survival
Neoplasms

ASJC Scopus subject areas

  • Surgery

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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. / Manes, Gianpiero; De Bellis, Mario; Fuccio, Lorenzo; Repici, Alessandro; Masci, Enzo; Ardizzone, Sandro; Mangiavillano, Benedetto; Carlino, Alessandra; Rossi, Giovanni Battista; Occhipinti, Pietro; Cennamo, Vincenzo.

In: Archives of Surgery, Vol. 146, No. 10, 10.2011, p. 1157-1162.

Research output: Contribution to journalArticle

Manes, Gianpiero ; De Bellis, Mario ; Fuccio, Lorenzo ; Repici, Alessandro ; Masci, Enzo ; Ardizzone, Sandro ; Mangiavillano, Benedetto ; Carlino, Alessandra ; Rossi, Giovanni Battista ; Occhipinti, Pietro ; Cennamo, Vincenzo. / 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. In: Archives of Surgery. 2011 ; Vol. 146, No. 10. pp. 1157-1162.
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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). Technicaland 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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T1 - Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent

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AU - Manes, Gianpiero

AU - De Bellis, Mario

AU - Fuccio, Lorenzo

AU - Repici, Alessandro

AU - Masci, Enzo

AU - Ardizzone, Sandro

AU - Mangiavillano, Benedetto

AU - Carlino, Alessandra

AU - Rossi, Giovanni Battista

AU - Occhipinti, Pietro

AU - Cennamo, Vincenzo

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N2 - 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). Technicaland 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.

AB - 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). Technicaland 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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