title: Through-the-scope large diameter self-expanding metal stent placement as a safe and effective technique for palliation of malignant colorectal obstruction: a single center experience with a long-term follow-up.
abstract: OBJECTIVE
  The aim of this study was to evaluate the outcomes of through-the-scope (TTS) large diameter self-expanding metal stent (SEMS) placement for palliation of malignant colorectal obstruction.
  
  
  METHODS
  Between January 2005 and December 2009, all patients who underwent endoscopic SEMS placement for palliation of malignant colorectal obstruction were prospectively enrolled.
  
  
  RESULTS
  Thirty-nine patients (17M and 22F; mean age 75.9 ± 10.6 years, range 50-91) were enrolled. The most frequent location was the sigmoid colon (13 cases). The causes of obstruction were colorectal malignancy in 32 patients and extracolonic malignancy in 7. Technical success was achieved in 36/39 patients (92.3%) and clinical success in 35/39 patients (89.7%). Technical failure was related to female sex (p = 0.04) and the extracolonic etiology of the stricture (p < 0.001). There were three early complications: two procedure-related perforations successfully managed conservatively and one hemorrhage treated with APC. Early complications were related to the location of strictures at the recto-sigmoid junction (p < 0.001). Late complications occurred in 10 patients: 8 of these patients experienced occlusive symptoms (attributable to tumor ingrowth in 5 cases and stool impaction in 3 cases); the remaining 2 were one case of tumor ingrowth with sub-occlusive symptoms and hemorrhage, and one case of distal migration. There was no procedure-related mortality and all complications were managed without surgical intervention. SEMS patency duration was 236 ± 128 days (range 31-497) and mean survival of the patients was 259 ± 121 days (range, 32-511).
  
  
  CONCLUSIONS
  In our experience, TTS large-diameter SEMS placement is a safe and effective treatment for palliation of malignant colorectal obstruction.
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy. carmeluigiano@libero.it
authors.forename: Carmelo
authors.initials: C
authors.lastname: Luigiano
authors.forename: Francesco
authors.initials: F
authors.lastname: Ferrara
authors.forename: Carlo
authors.initials: C
authors.lastname: Fabbri
authors.forename: Stefania
authors.initials: S
authors.lastname: Ghersi
authors.forename: Marco
authors.initials: M
authors.lastname: Bassi
authors.forename: Paola
authors.initials: P
authors.lastname: Billi
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Polifemo
authors.forename: Patrizia
authors.initials: P
authors.lastname: Landi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cennamo
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Consolo
authors.forename: Carmela
authors.initials: C
authors.lastname: Morace
authors.forename: Angela
authors.initials: A
authors.lastname: Alibrandi
authors.forename: Nicola
authors.initials: N
authors.lastname: D'Imperio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000209:etiology / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010166:Palliative Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome