The Learning Curve for Colorectal Stent Insertion for the Treatment of Malignant Colorectal Obstruction

BACKGROUND/AIMS: We aimed to assess the effectiveness of self-expanding metal stent (SEMS) insertion by evaluating the learning curve in relation to the experience of an endoscopist. METHODS: We retrospectively analyzed the outcomes of 120 SEMS insertion procedures performed by one endoscopist in patients with malignant colorectal obstruction. We compared the technical and clinical success rates, complication rates, and duration of the procedures by quartiles. RESULTS: The mean age of the patients (76 men and 44 women) was 64.6 years. The overall technical success rate was 95.0% (114/120), and the clinical success rate was 90.0% (108/120). The median procedure duration was 16.2 minutes (range, 3.4 to 96.5 minutes). From the first to the last quartile, the technical success rates were 90.0%, 96.7%, 96.7%, and 96.7% (p=0.263), and the clinical success rates were 90.0%, 90.0%, 96.7%, and 83.3% (p=0.588), respectively. Procedure-related complications were observed in 28 patients (23.3%). The complication rates for SEMS insertion when patients were divided by quartiles were 26.7%, 23.3%, 10.0%, and 33.3% (p=0.184), respectively. Moreover, the number of stents per procedure was 1.13, 1.03, 1.00, and 1.00 (p=0.029), respectively. The median duration of SEMS insertion decreased significantly, 20.9 to 14.8 minutes after the first 30 procedures (p=0.005). CONCLUSIONS: An experienced endoscopist was able to perform the SEMS insertion procedure easily and effectively after performing 30 SEMS insertions.

Comparison of Effects of Preoperative Stenting for Obstructing Colorectal Cancers according to the Location of the Obstructing Lesion / 대한소화기학회지

BACKGROUND/AIMS: With the development of self-expanding metallic stents, colonic obstruction can be relieved without the need for surgery. The results of preoperative placement of stents for malignant colorectal obstruction might be different according to the obstructing lesion. The objective of this study was to compare clinical improvement rates and operative results after preoperative placement of stents for malignant colorectal obstruction according to the location of the obstructing lesion. METHODS: This is a retrospective study including 57 patients who underwent self-expanding metallic stent insertion for obstructing resectable colorectal cancers. Patients were classified into three groups according to the location of the lesion as follows: proximal to the sigmoid colon (Group A), sigmoid colon (Group B), and rectum (Group C). RESULTS: The number of patients in A, B, and C groups was 13, 22, and 22, respectively. No significant differences in age, gender, stent type, and accompanying diseases among the three groups were observed. There were no significant differences in stent-related complications, clinical improvement rates, and one-stage resection rates among the three groups. The postoperative complications, the requirement rate of ICU care, the period of ICU stay, postoperative hospital stay, and hospital mortality did not significantly differ among the three groups. CONCLUSIONS: Clinical improvement rates and operative results after successful placement of stents for obstructing resectable colorectal cancers are not different according to the location of the obstructing lesion, suggesting that preoperative stenting for one-stage curative resection is useful, irrespective of the location of lesion.

Usefulness of a Self-expandable Nitinol Stent Through an Endoscope for the Treatment of a Malignant Colorectal Obstruction / 대한소화기내시경학회지

BACKGROUND/AIMS: Expandable stents were inserted for temporary decompression of the colorectum before single-stage surgery or for palliation. The aim of this study was to evaluate the usefulness of a self-expandable nitinol stent, which can be placed through the working channel of an endoscope, for treatment of malignant colorectal obstructions. METHODS: From May 2000 to April 2001, twenty patients (eleven female, nine male, aged 39~81 years) with malignant colorectal obstructions were treated for relief from the obstructions with endoscopically guided intubation of an expandable nitinol stent through the working channel of an endoscope. Of twenty patients, thirteen underwent placement of the stent for presurgical decompression; seven, for palliative decompression. RESULTS: The site of obstructions were on the rectum (n=8), sigmoid colon (n=6), descending colon (n=2), transverse colon (n=3) and ascending colon (n=1). Stent placement was successful in 18 (90%) of the 20 patients. Failure occurred in two patients with long and tortuous lesions involving hepatic flexure or splenic flexure. All patients tolerated placement of the stent well, with no procedure-related complications. In patients with successful placement of the stent, symptoms of obstruction resolved within 72 hours. Twelve patients underwent the formal bowel preparation and elective single-stage surgery without complications 4~7 days after stent placement. In six patients, the stents provided palliative decompression of the colorectum. There was stent migration in two patients during follow-up. CONCLUSIONS: Placement of a self-expandable nitinol stent through the working channel of an endoscope is technically feasible and safe. Stent placement allowed patients with malignant colorectal obstruction to undergo single-stage surgery in cases of operable disease and to provide palliative decompression in cases of inoperable disease.