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Effectiveness of stent placement for palliative treatment in malignant colorectal obstruction and predictive factors for stent occlusion
Surgical Endoscopy, 07/01/09

Suh JP et al. - In a trial to evaluate the effectiveness of stent placement for palliative treatment and to identify predictive factors associated with stent occlusion, it was reported that uncovered self-expandable metallic stent (SEMS) placement is an effective palliative treatment for malignant colorectal obstruction. The degree of stent expansion 48 hr after stent placement is significantly associated with maintenance of stent patency and is a predictive factor for stent occlusion.

Methods

A retrospective analysis was performed in 55 pts who had undergone placement of an uncovered SEMS for palliative treatment of malignant colorectal obstruction with metastatic or locally advanced cancer that was surgically unresectable.
Technical and clinical outcomes of stent placement, complications related to the procedure, stent patency rate, and predictive factors associated with stent occlusion were analyzed.

Results

Causes of colorectal obstruction before stent placement were primary colorectal cancer in 42 pts and noncolorectal extrinsic cancer in 13 pts.
Initial technical success rate was 98.2%, and clinical success rate was 94.4%.
Complications occurred in 17 pts (30.9%), including stent occlusion (n=8), migration (n=6), bowel perforation (n=1), stent distortion (n=1), and fistula formation (n=1).
Mean and median stent patency periods were 184 days and 141 days, respectively.
Degree of expansion 48 hr after stent placement was significantly better in the nonocclusion group than in the stent occlusion group.
Insufficient stent expansion (<70%) 48 hr after stent placement was significantly associated with an increase in stent occlusion during the follow-up period.

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