Clinical outcomes and patency of self-expanding metal stents in patients with malignant colorectal obstruction: a prospective single center study

Abstract

BACKGROUNDS AND AIMS: Self-expanding metal stents (SEMS) have been used as a palliative treatment for malignant colorectal obstruction. However, the reports about primary stent patency rate and associated factors have been limited. This study was performed to evaluate clinical outcomes and factors associated with long-term complications and patency of SEMS in patients with malignant colorectal obstruction. MATERIALS AND METHODS: Patients who underwent palliative endoscopic placement with uncovered SEMS for a malignant colorectal obstruction were prospectively enrolled at Seoul National University Hospital between April 2005 and August 2007. RESULTS: Forty-nine patients underwent 51 SEMS placements. Obstruction sites were rectum in 15 patients (30.6%), descending or sigmoid colon in 25 (51.0%), and transverse colon in nine (18.4%), respectively. The causes of obstruction were colorectal cancer in 36 patients (73.5%), direct invasion of gastric cancer in seven (14.3%) and others in six (12.2%). Technical success was achieved in 100% and clinical success in 86%, and there was one procedure-related perforation. Re-obstruction and migration occurred in 16% and 6%, respectively, during mean follow-up period of 331 days. Median stent patency duration was 204 days, and patency rates at 30, 90, and 180 days were 91.2%, 81.0%, and 53.3%, respectively, which was not associated with patient demographics, site of obstruction, or palliative chemotherapy. CONCLUSION: Endoscopic SEMS placement is a safe and effective palliative treatment for malignant colorectal obstruction, and overall long-term complication and patency were favorable irrespective of the palliative chemotherapy.