Factors related to difficult self‐expandable metallic stent placement for malignant colonic obstruction: A post‐hoc analysis of a multicenter study across Japan

Kuwai, Toshio; Yamaguchi, Toshiki; Imagawa, Hiroki; Yoshida, Shuntaro; Isayama, Hiroyuki; Matsuzawa, T.; Yamada, Terumasa; Saito, Shuji; Shimada, M.; Hirata, Nobuto; Sasaki, Takashi; Koizumi, Koichi; Maetani, Iruru; Saida, Yoshihisa

doi:10.1111/den.13260

Cited by 53 publications

(50 citation statements)

References 27 publications

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“…Pooled analyses of mainly retrospective data from series that mostly included patients with malignant strictures, also revealed an increased risk of perforation after stricture dilation [63,69,70]. In addition, no significant effects of balloon dilation on technical success [48,67] and clinical success [67] were observed.…”

Section: Technical Considerations Of Colonic Stentingmentioning

confidence: 96%

“…Among studies published since 2014, use of a cleansing enema before stent placement was mentioned in only 16.4 %, and in 1.2 % oral bowel preparation was performed according to tolerance or in the circumstances of incomplete obstruction. A post hoc analysis of a prospective multicenter study showed that preparation with a cleansing enema facilitated stent placement, resulting in slightly fewer procedures exceeding a procedure time beyond the 75th percentile (23.8 % vs. 28.9 %, odds ratio [OR] 0.5, P < 0.01) [48].…”

Section: Recommendationmentioning

confidence: 99%

“…A post hoc evaluation of a prospective observational study revealed that stricture length of at least 5 cm was associated with technical difficulty in colonic stenting [48], whereas another retrospective study comparing strictures up to 4 cm and longer than 4 cm revealed no significant differences in technical success, clinical success, and re-obstruction [122]. Boyle et al showed that shorter strictures and wider angulation distal to the obstruction were significantly associated with successful deployment and clinical decompression [123].…”

Section: Recommendationmentioning

confidence: 99%

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Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020

et al. 2020

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Main RecommendationsThe following recommendations should only be applied after a thorough diagnostic evaluation including a contrast-enhanced computed tomography (CT) scan. 1 ESGE recommends colonic stenting to be reserved for patients with clinical symptoms and radiological signs of malignant large-bowel obstruction, without signs of perforation. ESGE does not recommend prophylactic stent placement.Strong recommendation, low quality evidence. 2 ESGE recommends stenting as a bridge to surgery to be discussed, within a shared decision-making process, as a treatment option in patients with potentially curable left-sided obstructing colon cancer as an alternative to emergency resection.Strong recommendation, high quality evidence. 3 ESGE recommends colonic stenting as the preferred treatment for palliation of malignant colonic obstruction.Strong recommendation, high quality evidence. 4 ESGE suggests consideration of colonic stenting for malignant obstruction of the proximal colon either as a bridge to surgery or in a palliative setting.Weak recommendation, low quality evidence. 5 ESGE suggests a time interval of approximately 2 weeks until resection when colonic stenting is performed as a bridge to elective surgery in patients with curable left-sided colon cancer.Weak recommendation, low quality evidence. 6 ESGE recommends that colonic stenting should be performed or directly supervised by an operator who can demonstrate competence in both colonoscopy and fluoroscopic techniques and who performs colonic stenting on a regular basis.Strong recommendation, low quality evidence. 7 ESGE suggests that a decompressing stoma as a bridge to elective surgery is a valid option if the patient is not a candidate for colonic stenting or when stenting expertise is not available.Weak recommendation, low quality evidence.

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Section: Technical Considerations Of Colonic Stentingmentioning

confidence: 96%

Section: Recommendationmentioning

confidence: 99%

Section: Recommendationmentioning

confidence: 99%

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Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020

et al. 2020

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“…In Japan, the Japan Colonic Stent Safe Procedure Research Group conducted a multicenter, prospective, clinical study that reported technical and clinical success rates of 97.9% and 95.5%, respectively, with a perforation rate of 2%, demonstrating that colonic stents can be safely inserted in Japan 24) . In an analysis of factors related to difficult stent placement using the same database, Kuwai et al concluded that technical challenges must be anticipated in cases with peritoneal carcinomatosis, a CROSS score of 0, or expansive strictures; in such cases, experienced clinicians should perform self-expandable metallic stent (SEMS) placement 34) .…”

Section: Short-term Outcomes Of Colonic Stentsmentioning

confidence: 99%

Current status of colonic stent for obstructive colorectal cancer in Japan; a review of the literature

Saida

2019

J Anus Rectum Colon

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Colorectal cancer is the most common cancer in Japan. Approximately 10%-20% of the patients with colorectal cancer present with large bowel obstruction, and those who present with malignant colonic obstruction (MCO) require urgent decompression because MCO can cause electrolytic fluid imbalance, colonic necrosis, bacterial translocation, and death. Placement of colonic stents (self-expandable metallic stents) for MCO is a major and standard endoscopic treatment that has been available since 2012 in Japan. This review presents the current conditions and future prospects of this procedure based on the literature. The current indication of colonic stent placement is malignant colorectal stenosis. One of the purposes of using stents is palliative treatment; further, its advantages over emergency surgery with colostomy include avoidance of colostomy, relief of obstruction, shorter hospitalization, and better quality of life. In addition, stent placement can also be used as a bridge to surgery since the duration of the hospitalization is shorter and postoperative complications, colostomy rates, and mortality rates are lower with elective than with emergency surgery. Although recent studies have reported low complication rates related to colonic stents, complications may still occur, highlighting the importance of good preparation, adequate staffing, backup systems, and informed consent. The current major problem related to colonic stents is the lack of evidence on patients' long-term prognoses for bridge to surgery purposes, awaiting the results of ongoing clinical research.

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“…Firstly, to our knowledge, the possibility of positioning a third stent-in-stent for recurrent intrastent tumor ingrowth has never been considered and described. Moreover, some presumptive technical difficulties and negative prognostic factors[26] did not interfere with the success and efficacy of the endoscopic palliation. For example, a significantly lower technical success of SEMS placement[27] and patency after SEMS placement[25] has been demonstrated in patients with carcinomatosis (83% vs 93% for technical success[27] and 118 d vs 361 d for SEMS patency[25]).…”

Section: Discussionmentioning

confidence: 99%

Tertiary stent-in-stent for obstructing colorectal cancer: A case report and literature review

Vanella

Coluccio

Giulio

et al. 2019

WJGE

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BACKGROUNDSelf-expandable metal stents (SEMSs) are frequently used in the setting of palliation for occluding, inoperable colorectal cancer (CRC). Among possible complications of SEMS positioning, re-obstruction is the most frequent. Its management is controversial, potentially involving secondary stent-in-stent placement, which has been poorly investigated. Moreover, the issue of secondary stent-in-stent re-obstruction and of more-than-two colonic stenting has never been assessed. We describe a case of tertiary SEMS-in-SEMS placement, and also discuss our practice based on available literature.CASE SUMMARYA 66-year-old male with occluding and metastatic CRC was initially treated by positioning of a SEMS, which had to be revised 6 mo later when a symptomatic intra-stent tumor ingrowth was treated by a SEMS-in-SEMS. We hereby describe an additional episode of intestinal occlusion due to recurrence of intra-stent tumor ingrowth. This patient, despite several negative prognostic factors (splenic flexure location of the tumor, carcinomatosis with ascites, subsequent chemotherapy that included bevacizumab and two previously positioned stents (1 SEMS and 1 SEMS-in-SEMS)) underwent successful management through the placement of a tertiary SEMS-in-SEMS, with immediate clinical benefit and no procedure-related adverse events after 150 d of post-procedural follow-up. This endoscopic management has permitted 27 mo of partial control of a metastatic disease without the need for chemotherapy discontinuation and, ultimately, a good quality of life until death.CONCLUSIONTertiary SEMS-in-SEMS is technically feasible, and appears to be a safe and effective option in the case of recurrent SEMS obstruction.

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Factors related to difficult self‐expandable metallic stent placement for malignant colonic obstruction: A post‐hoc analysis of a multicenter study across Japan

Abstract: Clinicians must anticipate technical challenges in cases with peritoneal carcinomatosis, a CROSS score of 0, or expansive strictures; such cases require experienced clinicians to carry out SEMS placement.

Cited by 53 publications

References 27 publications

Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020

Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020

Current status of colonic stent for obstructive colorectal cancer in Japan; a review of the literature

Tertiary stent-in-stent for obstructing colorectal cancer: A case report and literature review

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