Technical and Clinical Outcomes Following Colonic Stenting: A Seven-Year Analysis of 268 Procedures

Little, Mark W.; Oakley, Thomas; Briggs, James; Sutcliffe, James; Allouni, A K; Makris, Gregory C.; Bratby, Mark; Tapping, Charles R.; Patel, Raf; Wigham, Andrew; Anthony, Suzie; Phillips‐Hughes, Jane; Uberoi, Raman

doi:10.1007/s00270-016-1391-5

Cited by 6 publications

(5 citation statements)

References 21 publications

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“…Migration rates range from 1 % to 10 %, with some evidence that chemotherapy may be associated with higher rates because of tumor shrinkage [58,61,76,83,86,101,103 Stent occlusion due to overgrowth of malignant tissue, fecal impaction, or tumor ingrowth through the mesh occurs in 3 % -29 % of cases, with higher rates reported in studies with longer follow-up and in cases of incomplete stent expansion [61,83,86,143,171,173,175,184,196,206].…”

Section: Recommendationmentioning

confidence: 99%

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: Recommendationmentioning

confidence: 99%

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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“…52,54,55 Old age, long segment involvement, and angulated strictures have been identified as risk factors for perforation. 49,56,57 A previous prospective study and systematic review have reported perforation rates of 3% to 5%. 19,48,52,[58][59][60] Meanwhile, some studies have reported high perforation rates of 10% to 13%.…”

Section: ) Perforationmentioning

confidence: 99%

“…The clinical success rate for colon stenting has been reported to be 65% to 100%. [41][42][43][44][45][46][47][48][49] This indicates that in the vast majority of cases, colorectal stents could be placed in the correct position and fully expanded to relieve obstruction. Most patients experience symptom improvement after stent placement, such as relief from abdominal pain and resumption of normal bowel movements.…”

Section: Clinical Outcomes Of Sems Use Technical and Clinical Successmentioning

confidence: 99%

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Colon stenting as a bridge to surgery in obstructive colorectal cancer management

Kim,

Lee

2024

Clin Endosc

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Colorectal cancer is one of the most common malignancies worldwide, and its prevalence is gradually increasing. 1,2 Large bowel obstruction caused by colorectal cancer occurs in 7% to 29% of patients with this cancer. [3][4][5] Conventionally, patients with obstructive colorectal cancer are treated with emergency surgery, which is associated with high morbidity and mortality Colonic stent placement is a commonly used bridging strategy for surgery in patients with obstructive colorectal cancer. The procedure involves the placement of a self-expandable metallic stent (SEMS) across the obstructive lesion to restore intestinal patency and alleviate the symptoms of obstruction. By allowing patients to receive surgery in a planned and staged manner with time for preoperative optimization and bowel preparation, stent placement may reduce the need for emergency surgery, which is associated with higher complication rates and poorer outcomes. This review focuses on the role of colon stenting as a bridge to surgery in the management of obstructive colorectal cancer. SEMS as a bridge to surgery for left-sided colon cancer has been demonstrated to be particularly useful; however, further research is needed for its application in cases of right-sided colon cancer. Colon stent placement also has limitations and potential complications including stent migration, re-obstruction, and perforation. However, the timing of curative surgery after SEMS placement remains inconclusive. Considering the literature to date, performing surgery at an interval of approximately 2 weeks is considered appropriate. Therefore, colonic stent placement may be an effective strategy as a bridge to surgery in patients with obstructive colorectal cancer.

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“…Colorectal cancer (CRC) is the third most common diagnosed cancer in males and the second in females; it caused 83,200 deaths globally in 2015 (6). At the time of diagnosis, 10–30% of patients with CRC have acute large bowel obstruction (7,8). Emergent decompression is necessary for large bowel obstruction, and self-expandable metallic stent (SEMS) placement is a clinical choice as a minimally invasive non-surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Detection of circulating colorectal cancer cells by a custom microfluid system before and after endoscopic metallic stent placement

et al. 2019

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Although the detection of circulating tumor cells (CTCs) should be crucial for future personalized medicine, no efficient and flexible methods have been established. The current study established a polymeric custom-made chip for capturing CTCs with a high efficiency and flexibility. As an example of clinical application, the effects of self-expandable metallic stent (SEMS) placement on the release of cancer cells into the blood of patients with colorectal cancer and bowel obstruction were analyzed. This was assessed as the placement of SEMS may cause mechanical damage and physical force to malignant tissue, increasing the risk of cancer cell release into the bloodstream. The present study examined the number of CTCs using a custom-made chip, before, at 24 h after and at 4 days after SEMS placement in patients with colorectal cancer. The results revealed that, among the 13 patients examined, the number of CTCs was increased in three cases at 24 h after SEMS placement. However, this increase was temporary. The number of CTCs also decreased at 4 days after stent placement in most cases. The CTC chip of the current study detected the number of CD133-positive cancer stem-like cells, which did not change, even in the patient whose total number of CTCs temporarily increased. The results indicated that this custom-made microfluid system can efficiently and flexibly detect CTCs, demonstrating its potential for obtaining information during the management of patients with cancer.

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Technical and Clinical Outcomes Following Colonic Stenting: A Seven-Year Analysis of 268 Procedures

Abstract: Lesion size, location and duration of obstructive symptoms are statistically significant determinants of patient outcome. These factors could be used to advise patient selection for colonic stenting or direct progression to surgical intervention.

Cited by 6 publications

References 21 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

Colon stenting as a bridge to surgery in obstructive colorectal cancer management

Detection of circulating colorectal cancer cells by a custom microfluid system before and after endoscopic metallic stent placement

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