Journal
GASTROINTESTINAL ENDOSCOPY
Volume 82, Issue 4, Pages 697-+Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.gie.2015.03.1978
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Funding
- Boston Scientific Japan
- Century Medical Inc
- ZEON
- Taewong Medical
- Piolax Medical Devices
- Olympus Medical Systems
- MC Medica
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Background: Endoscopic self-expandable metal stent placement has been used as an alternative to surgery for malignant colorectal obstruction; however, factors affecting its clinical outcome are unclear. Objective: To clarify the short-term safety and efficacy of endoscopic self-expandable metal stent placement for malignant colorectal obstruction and to identify factors associated with its clinical and technical failure. Design: Prospective clinical cohort study. Setting: Fourteen academic centers and 32 community hospitals. Patients: A total of 513 consecutive patients with malignant colorectal obstruction. Intervention: Endoscopic self-expandable metal stent placement, sharing of stent placement methods among participating facilities. Main Outcome Measurements: The primary endpoint was clinical success, defined as symptom and radiological finding resolution within 24 hours. Secondary endpoints were technical success and adverse events. The follow-up period was 7 days. Results: The clinical and technical success rates were 95.5% and 97.9%, respectively. Major adverse events included perforation (2.1%), stent migration (1.0%), and stent occlusion (0.8%). The main causes of perforation were the procedure itself (0.8%) and comorbidities (obstructive colitis and impending perforation) not apparent before stent placement (0.6%). Extrinsic tumor origin was independently associated with the clinical failure after stent placement (odds ratio 4.23; 95% confidence interval, 1.21-14.79; P = . 02). Stricture marking trended toward a negative association with technical failure (P =.09). Limitations: Noncomparative study. Conclusion: Strict inclusion criteria and stricture marking may improve the technical and clinical success of stent placement.
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