A Japanese prospective multicenter study of self-expandable metal stent placement for malignant colorectal obstruction: short-term safety and efficacy within 7 days of stent procedure in 513 cases

• Published in: Gastrointestinal endoscopy Vol. 82; no. 4; pp. 697 - 707.e1
• Main Authors: Matsuzawa, Takeaki, MD, Ishida, Hideyuki, MD, Yoshida, Shuntaro, MD, Isayama, Hiroyuki, MD, Kuwai, Toshio, MD, Maetani, Iruru, MD, Shimada, Mamoru, MD, Yamada, Tomonori, MD, Saito, Shuji, MD, Tomita, Masafumi, MD, Koizumi, Koichi, MD, Hirata, Nobuto, MD, Sasaki, Takashi, MD, Enomoto, Toshiyuki, MD, Saida, Yoshihisa, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015
• Subjects: Adult; Aged; Colorectal Neoplasms - complications; Feasibility Studies; Female; Follow-Up Studies; Gastroenterology and Hepatology; Humans; Intestinal Obstruction - etiology; Intestinal Obstruction - therapy; Japan; Male; Middle Aged; Prospective Studies; Self Expandable Metallic Stents; Treatment Outcome; Japan; BTS; bridge to surgery; PS; palliative; ColoRectal Obstruction Scoring System; CROSS; PAL; performance status; self-expandable metal stent; SEMS
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2015.03.1978

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.