Effectiveness of stent placement for palliative treatment in malignant colorectal obstruction and predictive factors for stent occlusion.
BACKGROUND
Self-expandable metallic stent (SEMS) for malignant colorectal obstruction is widely used in palliative treatment and as an alternative to surgery. The aims of this study are to evaluate the effectiveness of stent placement for palliative treatment and to identify the predictive factors associated with stent occlusion.


METHODS
A retrospective analysis was performed in 55 patients who had undergone placement of an uncovered SEMS from February 2004 to April 2007 for palliative treatment of malignant colorectal obstruction with metastatic or locally advanced cancer that was surgically unresectable. We analyzed the technical and clinical outcomes of stent placement, complications related to the procedure, stent patency rate, and predictive factors associated with stent occlusion.


RESULTS
The causes of colorectal obstruction before stent placement were primary colorectal cancer in 42 patients and noncolorectal extrinsic cancer in 13 patients. The initial technical success rate was 98.2%, and the clinical success rate was 94.4%. Complications occurred in 17 patients (30.9%). These included stent occlusion (n = 8), migration (n = 6), bowel perforation (n = 1), stent distortion (n = 1), and fistula formation (n = 1). The mean and median stent patency periods were 184 days [95% confidence interval (CI), 137-230 days] and 141 days (95% CI, 69-213 days), respectively. The degree of expansion 48 h after stent placement was significantly better in the nonocclusion group than in the stent occlusion group. In the multivariate Cox proportional hazard model, insufficient stent expansion (<70%) 48 h after stent placement was significantly associated with an increase in stent occlusion during the follow-up period (odds ratio, 12.55; p = 0.002).


CONCLUSIONS
Uncovered SEMS placement is an effective palliative treatment for malignant colorectal obstruction. The degree of stent expansion 48 h after stent placement is significantly associated with the maintenance of stent patency and is a predictive factor for stent occlusion.
Suh
Jung Pil
JP
Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
Kim
Sang Woo
SW
Cho
Yu Kyung
YK
Park
Jae Myung
JM
Lee
In Seok
IS
Choi
Myung-Gyu
MG
Chung
In-Sik
IS
Kim
Hyung Jin
HJ
Kang
Won Kyung
WK
Oh
Seong Taek
ST
D000230:Adenocarcinoma / Q000150:complications*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications; D003108:Colonic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000209:etiology; D005833:Genital Neoplasms, Female / Q000150:complications; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000150:complications