Endoscopic stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery

Bo Kyung Kim, Sung Pil Hong, Hyun Mi Heo, Jin Young Kim, Hyuk Hur, Kang Young Lee, Jae Hee Cheon, Tae Il Kim, Won Ho Kim

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Although self-expandable metal stent (SEMS) insertion has been shown to be an effective therapy for palliation of obstruction from colorectal malignancy, the clinical efficacy of SEMS insertion in the palliation of colorectal obstruction from an extracolonic malignancy (ECM) has not been extensively evaluated. Objective: The aim of this study was to evaluate the clinical outcomes and complications of SEMSs compared with those of emergency surgery for relief of colorectal obstruction in patients with advanced gastric cancer (AGC). Design: Retrospective study. Patients: From January 2000 to December 2009, patients with AGC who were treated with SEMSs (N = 111) or emergency surgery (N = 69) for palliation of malignant colorectal obstruction were included. Intervention: SEMS insertion or surgery. Results: Although acute complications and stoma formations were lower in the SEMS group than in the surgery group, the clinical efficacy of SEMSs was inferior to emergency surgery (technical success, 73.9% vs 94.2%, P =.001; clinical success, 54.1% vs 75.4%, P =.005). SEMS-related complications occurred in 64.5%, including reobstruction (36.8%), stent migration (10.5%), perforation (13.2%), and bleeding (3.9%). The median duration of patency was not statistically different between the patients who underwent SEMS insertion and those who underwent emergency surgery (117 days vs 183 days, P =.105). Patients with fewer than 2 obstructive sites or less than 2 years to obstructive symptom onset after diagnosis of AGC showed better clinical outcomes after endoscopic stenting. Limitations: Retrospective and single-center study. Conclusions: SEMS insertion seems to be less effective than emergency surgery for the palliation of colorectal obstruction in patients with AGC. Further study is necessary to define those patients with ECM who may benefit from SEMS insertion.

Original languageEnglish
Pages (from-to)294-301
Number of pages8
JournalGastrointestinal Endoscopy
Volume75
Issue number2
DOIs
Publication statusPublished - 2012 Feb 1

Fingerprint

Stomach Neoplasms
Emergencies
Colorectal Surgery
Neoplasms
Self Expandable Metallic Stents
Ambulatory Surgical Procedures
Stents
Retrospective Studies
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Kim, Bo Kyung ; Hong, Sung Pil ; Heo, Hyun Mi ; Kim, Jin Young ; Hur, Hyuk ; Lee, Kang Young ; Cheon, Jae Hee ; Kim, Tae Il ; Kim, Won Ho. / Endoscopic stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery. In: Gastrointestinal Endoscopy. 2012 ; Vol. 75, No. 2. pp. 294-301.
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title = "Endoscopic stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery",
abstract = "Background: Although self-expandable metal stent (SEMS) insertion has been shown to be an effective therapy for palliation of obstruction from colorectal malignancy, the clinical efficacy of SEMS insertion in the palliation of colorectal obstruction from an extracolonic malignancy (ECM) has not been extensively evaluated. Objective: The aim of this study was to evaluate the clinical outcomes and complications of SEMSs compared with those of emergency surgery for relief of colorectal obstruction in patients with advanced gastric cancer (AGC). Design: Retrospective study. Patients: From January 2000 to December 2009, patients with AGC who were treated with SEMSs (N = 111) or emergency surgery (N = 69) for palliation of malignant colorectal obstruction were included. Intervention: SEMS insertion or surgery. Results: Although acute complications and stoma formations were lower in the SEMS group than in the surgery group, the clinical efficacy of SEMSs was inferior to emergency surgery (technical success, 73.9{\%} vs 94.2{\%}, P =.001; clinical success, 54.1{\%} vs 75.4{\%}, P =.005). SEMS-related complications occurred in 64.5{\%}, including reobstruction (36.8{\%}), stent migration (10.5{\%}), perforation (13.2{\%}), and bleeding (3.9{\%}). The median duration of patency was not statistically different between the patients who underwent SEMS insertion and those who underwent emergency surgery (117 days vs 183 days, P =.105). Patients with fewer than 2 obstructive sites or less than 2 years to obstructive symptom onset after diagnosis of AGC showed better clinical outcomes after endoscopic stenting. Limitations: Retrospective and single-center study. Conclusions: SEMS insertion seems to be less effective than emergency surgery for the palliation of colorectal obstruction in patients with AGC. Further study is necessary to define those patients with ECM who may benefit from SEMS insertion.",
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Endoscopic stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery. / Kim, Bo Kyung; Hong, Sung Pil; Heo, Hyun Mi; Kim, Jin Young; Hur, Hyuk; Lee, Kang Young; Cheon, Jae Hee; Kim, Tae Il; Kim, Won Ho.

In: Gastrointestinal Endoscopy, Vol. 75, No. 2, 01.02.2012, p. 294-301.

Research output: Contribution to journalArticle

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T1 - Endoscopic stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery

AU - Kim, Bo Kyung

AU - Hong, Sung Pil

AU - Heo, Hyun Mi

AU - Kim, Jin Young

AU - Hur, Hyuk

AU - Lee, Kang Young

AU - Cheon, Jae Hee

AU - Kim, Tae Il

AU - Kim, Won Ho

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N2 - Background: Although self-expandable metal stent (SEMS) insertion has been shown to be an effective therapy for palliation of obstruction from colorectal malignancy, the clinical efficacy of SEMS insertion in the palliation of colorectal obstruction from an extracolonic malignancy (ECM) has not been extensively evaluated. Objective: The aim of this study was to evaluate the clinical outcomes and complications of SEMSs compared with those of emergency surgery for relief of colorectal obstruction in patients with advanced gastric cancer (AGC). Design: Retrospective study. Patients: From January 2000 to December 2009, patients with AGC who were treated with SEMSs (N = 111) or emergency surgery (N = 69) for palliation of malignant colorectal obstruction were included. Intervention: SEMS insertion or surgery. Results: Although acute complications and stoma formations were lower in the SEMS group than in the surgery group, the clinical efficacy of SEMSs was inferior to emergency surgery (technical success, 73.9% vs 94.2%, P =.001; clinical success, 54.1% vs 75.4%, P =.005). SEMS-related complications occurred in 64.5%, including reobstruction (36.8%), stent migration (10.5%), perforation (13.2%), and bleeding (3.9%). The median duration of patency was not statistically different between the patients who underwent SEMS insertion and those who underwent emergency surgery (117 days vs 183 days, P =.105). Patients with fewer than 2 obstructive sites or less than 2 years to obstructive symptom onset after diagnosis of AGC showed better clinical outcomes after endoscopic stenting. Limitations: Retrospective and single-center study. Conclusions: SEMS insertion seems to be less effective than emergency surgery for the palliation of colorectal obstruction in patients with AGC. Further study is necessary to define those patients with ECM who may benefit from SEMS insertion.

AB - Background: Although self-expandable metal stent (SEMS) insertion has been shown to be an effective therapy for palliation of obstruction from colorectal malignancy, the clinical efficacy of SEMS insertion in the palliation of colorectal obstruction from an extracolonic malignancy (ECM) has not been extensively evaluated. Objective: The aim of this study was to evaluate the clinical outcomes and complications of SEMSs compared with those of emergency surgery for relief of colorectal obstruction in patients with advanced gastric cancer (AGC). Design: Retrospective study. Patients: From January 2000 to December 2009, patients with AGC who were treated with SEMSs (N = 111) or emergency surgery (N = 69) for palliation of malignant colorectal obstruction were included. Intervention: SEMS insertion or surgery. Results: Although acute complications and stoma formations were lower in the SEMS group than in the surgery group, the clinical efficacy of SEMSs was inferior to emergency surgery (technical success, 73.9% vs 94.2%, P =.001; clinical success, 54.1% vs 75.4%, P =.005). SEMS-related complications occurred in 64.5%, including reobstruction (36.8%), stent migration (10.5%), perforation (13.2%), and bleeding (3.9%). The median duration of patency was not statistically different between the patients who underwent SEMS insertion and those who underwent emergency surgery (117 days vs 183 days, P =.105). Patients with fewer than 2 obstructive sites or less than 2 years to obstructive symptom onset after diagnosis of AGC showed better clinical outcomes after endoscopic stenting. Limitations: Retrospective and single-center study. Conclusions: SEMS insertion seems to be less effective than emergency surgery for the palliation of colorectal obstruction in patients with AGC. Further study is necessary to define those patients with ECM who may benefit from SEMS insertion.

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