title: Severity of initial stent angulation predicts reintervention after successful palliative enteral stenting for malignant luminal obstruction.
abstract: OBJECTIVE
  Recurrent stent obstruction necessitating reintervention is problematic and incompletely understood. The aim of the present study was to identify factor(s) predisposing to reintervention.
  
  
  METHODS
  Retrospective review of patients (n = 117) referred to a single major endoscopic referral centre for palliative enteral stenting from 1999 to 2006. Twelve were excluded due to inadequate follow-up data (n = 7) or initial radiographic documentation (n = 5). A total of 105 patients (gastroduodenal n = 57, colonic n = 48) were therefore analyzed. The primary outcome of interest was recurrent obstruction necessitating reintervention. Kaplan-Meier analysis of potential factors predisposing to reintervention, including stent angulation (mild [<15°], moderate [15°-90°], severe [>90°]) was completed for 98 patients (technically successful enteral stenting).
  
  
  RESULTS
  Technical and clinical success were achieved in 98 of 105 (93.3%) and 92 of 98 (93.9%) cases, respectively. Post-stenting median survival was 97.5 days (range 3-1054). Eighteen patients (18.4%) required reintervention for stent obstruction at a median time to reintervention of 85 days (range 7-481). Increased stent angulation (severe vs mild hazard ratio 6.73 (95% confidence interval 1.59-27.59), P = 0.009) was the only statistically significant factor in multivariate analysis predicting reintervention.
  
  
  CONCLUSIONS
  Despite its limitation as a retrospective review, this study found that reintervention for stent obstruction is necessary in almost one in five cases, and increasing severity of stent angulation is the most important risk factor.
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Eric Y T
authors.initials: EY
authors.lastname: Lee
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bourke
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Williams
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alrubaie
authors.forename: Vu
authors.initials: V
authors.lastname: Kwan
authors.forename: Adam A
authors.initials: AA
authors.lastname: Bailey
authors.forename: Paul M
authors.initials: PM
authors.lastname: Lynch
authors.forename: Sze M
authors.initials: SM
authors.lastname: Loh
mesh_terms: D000368:Aged; D004067:Digestive System Neoplasms / Q000150:complications*; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D009517:New South Wales; D010166:Palliative Care; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D011859:Radiography; D019233:Retreatment; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome