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Abstract
Background/Aims
This study compared the clinical outcomes between endoscopic and radiologic placement of self-expandable metal stent (SEMS) in patients with malignant colorectal obstruction.
Methods
In total, 111 patients were retrospectively enrolled in this study between January 2003 and June 2011 at Seoul National University Boramae Hospital. Technical and clinical success rates, complication rates, and stent patency were compared between using an endoscopic (n=73) or radiologic (n=38) method during the SEMS placement procedure.
Results
The technical success rate was higher in the endoscopic method than in the radiologic method (100% [73/73] vs. 92.1% [35/38], respectively; p=0.038). In addition, in 3 of the remaining 35 patients in the radiologic-method group, adjuvant endoscopic assistance was required. In the six patients (including the three aforementioned patients), the causes of technical failure were the inability to pass the guidewire into an obstructive lesion due to a tortuous, curved angulation of the sigmoid or descending colon (n=4), and a difficult approach to a lesion located at the descending or transverse colon (n=2). The clinical success rate, complication rate, and stent patency did not differ significantly between the two methods (p=0.424, 0.303, and 0.423, respectively).
Conclusions
When the colorectal obstruction had a tortuous, curved angulation of the colon or was located at or proximal to the descending colon, the endoscopic method of SEMS placement appears to be more useful than the radiologic method. However, once SEMS placement was technically successful, the clinical success rate, complication rate, and stent patency did not differ with the method of insertion.
References
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Fig. 1.
Cumulative rates for stent patency duration between the endoscopic (dotted line) and radiologic (solid line) methods (p=0.423).
Table 1.
Baseline Characteristics of the Patients with Malignant Colorectal Obstruction according to the Method of Stent Placement
| Characteristic | Endoscopic method (n=73) | Radiologic method (n=38) | p-value |
|---|---|---|---|
| Sex (male/female) | 38/35 (52.1/47.9) | 23/15 (60.5/39.5) | 0.395 |
| Age (yr) | 67.0±13.0 (33–91) | 67.2±11.4 (38–85) | 0.929 |
| Locations of obstruction | 0.260 a | ||
| Left colon | 66 (90.4) | 37 (97.4) | |
| Rectum | 15 (20.5) | 9 (23.7) | |
| Sigmoid | 43 (58.9) | 26 (68.4) | |
| Descending | 8 (11.0) | 2 (5.3) | |
| Right colon | 7 (9.6) | 1 (2.7) | |
| Transverse | 5 (6.8) | 1 (2.6) | |
| Ascending | 2 (2.7) | 0 | |
| Stages | 0.748 | ||
| No metastasis | 38 (52.1) | 21 (55.3) | |
| Metastasis | 35 (47.9) | 17 (44.7) | |
| Carcinomatosis | 0.427 | ||
| Absent | 62 (84.9) | 30 (78.9) | |
| Present | 11 (15.1) | 8 (21.1) | |
| Etiology | 1.000 b | ||
| Intrinsic | 68 (93.2) | 36 (94.7) | |
| Extrinsic | 5 (6.8) | 2 (5.3) | |
| Gastric | 3 (60.0) | 2 (100.0) | |
| Gynecologic | 2 (40.0) | 0 (0.0) | |
| Purposes of stenting | 0.054 | ||
| Palliative | 39 (53.4) | 13 (34.2) | |
| Preoperative | 34 (46.6) | 25 (65.8) | |
| Length of obstruction (mm) | 39.4±14.1 | 44.2±17.3 | 0.125 |
| Types of inserted stent | 0.086 | ||
| Uncovered | 59 (80.8) | 23 (65.7) | |
| Covered | 14 (19.2) | 12 (34.3) | |
| Diameter of stent (mm) | 23.2±1.6 | 23.3±2.7 | 0.916 |
| Length of stent (mm) | 103.0±28.4 | 102.3±21.6 | 0.894 |
| No. of inserted stents at presentation | 0.658 | ||
| One | 70 (95.9) | 33 (94.3) | |
| Two | 3 (4.1) | 2 (5.7) | |
| Total procedure time (min) Palliative chemotherapy c | 25±15 n=39 | 31±15 n=13 | 0.066 0.733 |
| Yes | 12 (30.8) | 3 (23.1) | |
| No | 27 (69.2) | 10 (76.9) |
Table 2.
Technical and Clinical Success Rates, and Causes of Te chnical and Clinical Failures
| Endoscopic method | Radiologic method | p-value | |
|---|---|---|---|
| Technical success | 73 (100) | 35 (92.1) | 0.038 |
| Causes of technical failure | |||
| Inability to pass guidewire | 0 (0.0) | 2 (5.3) | 0.115 |
| Approach difficulties | 0 (0.0) | 1 (2.6) | 0.342 |
| Clinical success | 67 (91.8) | 34 (97.1) a | 0.424 |
| Causes of clinical failure | |||
| Incomplete expansion | 2 (2.7) | 1 (2.9) | 1.000 |
| Additional obstruction | 1 (1.4) | 0 (0.0) | 1.000 |
| Perforation | 2 (2.7) | 0 (0.0) | 1.000 |
| Migration | 1 (1.4) | 0 (0.0) | 1.000 |
Table 3.
Complications in the Patients Who Received Stent Placement for the Purpose of Palliation (n=50)
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