Clinical outcomes and risk factors for technical and clinical failures of self-expandable metal stent insertion for malignant colorectal obstruction

Jin Young Yoon, Yoon Suk Jung, Sung Pil Hong, Tae Il Kim, Won Ho Kim, JaeHee Cheon

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Abstract

Background: Although self-expandable metal stent (SEMS) insertion is widely used for relief of malignant colorectal obstructions, the immediate technical and clinical failure rates of SEMSs and the associated risk factors remain largely unknown. Objective: To identify rates and factors predictive of technical and clinical failure of SEMSs when their use is attempted for the decompression of malignant colorectal obstruction. Design: Retrospective chart review. Setting: A tertiary-care academic medical center in South Korea. Patients: This study involved a total of 412 patients with malignant colorectal obstruction in whom SEMS insertion was attempted. Intervention: Placement of colonic SEMSs. Main Outcome Measurements: Technical success and immediate and long-term clinical success rates. Results: Technical and clinical failures were found in 36 of 276 patients (13.0%) and 39 of 240 patients (16.3%) in the palliative group, respectively, and in 3 of 136 patients (2.2%) and 7 of 133 patients (5.3%) in the preoperative group, respectively. Factors associated with technical failure were extracolonic origin of tumor, the presence of carcinomatosis, and a proximal obstruction site. Factors associated with long-term clinical failure in the palliative group were combined dilation procedure, no additional chemotherapy, and extracolonic origin of the tumor. In the preoperative group, only older patients had both higher technical failure and clinical failure rates. Limitations: This was a single-institution, retrospective analysis. Conclusion: Although colorectal SEMS placement is generally safe and effective, it is associated with clinically important technical and clinical failure rates. The identification of risk factors for the failure of colorectal SEMSs found in this study might help physicians decide between surgical decompression and endoscopic stenting in patients with malignant colorectal obstruction.

Original languageEnglish
Pages (from-to)858-868
Number of pages11
JournalGastrointestinal Endoscopy
Volume74
Issue number4
DOIs
Publication statusPublished - 2011 Jan 1

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Surgical Decompression
Republic of Korea
Self Expandable Metallic Stents
Tertiary Healthcare
Decompression
Dilatation
Neoplasms
Carcinoma
Physicians
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

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title = "Clinical outcomes and risk factors for technical and clinical failures of self-expandable metal stent insertion for malignant colorectal obstruction",
abstract = "Background: Although self-expandable metal stent (SEMS) insertion is widely used for relief of malignant colorectal obstructions, the immediate technical and clinical failure rates of SEMSs and the associated risk factors remain largely unknown. Objective: To identify rates and factors predictive of technical and clinical failure of SEMSs when their use is attempted for the decompression of malignant colorectal obstruction. Design: Retrospective chart review. Setting: A tertiary-care academic medical center in South Korea. Patients: This study involved a total of 412 patients with malignant colorectal obstruction in whom SEMS insertion was attempted. Intervention: Placement of colonic SEMSs. Main Outcome Measurements: Technical success and immediate and long-term clinical success rates. Results: Technical and clinical failures were found in 36 of 276 patients (13.0{\%}) and 39 of 240 patients (16.3{\%}) in the palliative group, respectively, and in 3 of 136 patients (2.2{\%}) and 7 of 133 patients (5.3{\%}) in the preoperative group, respectively. Factors associated with technical failure were extracolonic origin of tumor, the presence of carcinomatosis, and a proximal obstruction site. Factors associated with long-term clinical failure in the palliative group were combined dilation procedure, no additional chemotherapy, and extracolonic origin of the tumor. In the preoperative group, only older patients had both higher technical failure and clinical failure rates. Limitations: This was a single-institution, retrospective analysis. Conclusion: Although colorectal SEMS placement is generally safe and effective, it is associated with clinically important technical and clinical failure rates. The identification of risk factors for the failure of colorectal SEMSs found in this study might help physicians decide between surgical decompression and endoscopic stenting in patients with malignant colorectal obstruction.",
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Clinical outcomes and risk factors for technical and clinical failures of self-expandable metal stent insertion for malignant colorectal obstruction. / Yoon, Jin Young; Jung, Yoon Suk; Hong, Sung Pil; Kim, Tae Il; Kim, Won Ho; Cheon, JaeHee.

In: Gastrointestinal Endoscopy, Vol. 74, No. 4, 01.01.2011, p. 858-868.

Research output: Contribution to journalArticle

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AU - Jung, Yoon Suk

AU - Hong, Sung Pil

AU - Kim, Tae Il

AU - Kim, Won Ho

AU - Cheon, JaeHee

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N2 - Background: Although self-expandable metal stent (SEMS) insertion is widely used for relief of malignant colorectal obstructions, the immediate technical and clinical failure rates of SEMSs and the associated risk factors remain largely unknown. Objective: To identify rates and factors predictive of technical and clinical failure of SEMSs when their use is attempted for the decompression of malignant colorectal obstruction. Design: Retrospective chart review. Setting: A tertiary-care academic medical center in South Korea. Patients: This study involved a total of 412 patients with malignant colorectal obstruction in whom SEMS insertion was attempted. Intervention: Placement of colonic SEMSs. Main Outcome Measurements: Technical success and immediate and long-term clinical success rates. Results: Technical and clinical failures were found in 36 of 276 patients (13.0%) and 39 of 240 patients (16.3%) in the palliative group, respectively, and in 3 of 136 patients (2.2%) and 7 of 133 patients (5.3%) in the preoperative group, respectively. Factors associated with technical failure were extracolonic origin of tumor, the presence of carcinomatosis, and a proximal obstruction site. Factors associated with long-term clinical failure in the palliative group were combined dilation procedure, no additional chemotherapy, and extracolonic origin of the tumor. In the preoperative group, only older patients had both higher technical failure and clinical failure rates. Limitations: This was a single-institution, retrospective analysis. Conclusion: Although colorectal SEMS placement is generally safe and effective, it is associated with clinically important technical and clinical failure rates. The identification of risk factors for the failure of colorectal SEMSs found in this study might help physicians decide between surgical decompression and endoscopic stenting in patients with malignant colorectal obstruction.

AB - Background: Although self-expandable metal stent (SEMS) insertion is widely used for relief of malignant colorectal obstructions, the immediate technical and clinical failure rates of SEMSs and the associated risk factors remain largely unknown. Objective: To identify rates and factors predictive of technical and clinical failure of SEMSs when their use is attempted for the decompression of malignant colorectal obstruction. Design: Retrospective chart review. Setting: A tertiary-care academic medical center in South Korea. Patients: This study involved a total of 412 patients with malignant colorectal obstruction in whom SEMS insertion was attempted. Intervention: Placement of colonic SEMSs. Main Outcome Measurements: Technical success and immediate and long-term clinical success rates. Results: Technical and clinical failures were found in 36 of 276 patients (13.0%) and 39 of 240 patients (16.3%) in the palliative group, respectively, and in 3 of 136 patients (2.2%) and 7 of 133 patients (5.3%) in the preoperative group, respectively. Factors associated with technical failure were extracolonic origin of tumor, the presence of carcinomatosis, and a proximal obstruction site. Factors associated with long-term clinical failure in the palliative group were combined dilation procedure, no additional chemotherapy, and extracolonic origin of the tumor. In the preoperative group, only older patients had both higher technical failure and clinical failure rates. Limitations: This was a single-institution, retrospective analysis. Conclusion: Although colorectal SEMS placement is generally safe and effective, it is associated with clinically important technical and clinical failure rates. The identification of risk factors for the failure of colorectal SEMSs found in this study might help physicians decide between surgical decompression and endoscopic stenting in patients with malignant colorectal obstruction.

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