title: Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent: analysis of results and predictors of outcomes in a large multicenter series.
abstract: OBJECTIVE
  To evaluate the short- and long-term efficacy of self-expanding metal stents (SEMSs) in patients with colorectal obstruction and incurable cancer and the related factors that affect outcomes.
  
  
  METHODS
  Retrospective analysis of SEMS placement for incurable colorectal obstruction in a 3-year period.
  
  
  METHODS
  Five tertiary care endoscopic centers.
  
  
  METHODS
  Consecutive patients (N = 201) undergoing stenting for incurable malignant obstruction.
  
  
  METHODS
  Clinical and technical success of stenting, complications rate, and factors affecting outcomes.
  
  
  RESULTS
  Technical success was achieved in 184 of 201 patients (91.5%) and clinical success occurred in 165 of 184 patients (89.7%; 82.1% of 201 patients). Technical and clinical failures were more frequent in extrinsic and long colorectal stenoses. Overall, 165 patients had normal bowel movements during follow-up (mean [SD], 115.5 [100.3] days; range, 1-500 days), 15 developed complications, 127 had a functioning SEMS at the time of death, and 23 were alive at completion of the study. Twenty-four (11.9%) major complications occurred: 11 migrations, 12 perforations, and 1 reobstruction. Migration of SEMSs was associated with stent diameter less than 25 mm. Bevacizumab therapy increased the risk of perforation by 19.6-fold. Karnofsky performance status of 50 or less was associated with shorter survival and a 3.7-fold higher risk of death within 6 months after the stent was placed.
  
  
  CONCLUSIONS
  The use of SEMSs is safe and effective for palliation of incurable malignant colonic obstruction; approximately 75% of patients with SEMSs are able to avoid colostomy.
authors: Department of Gastroenterology, University Hospital L. Sacco, Milano, Italy. gimanes@tin.it
authors: Gianpiero
authors: G
authors: Manes
authors: Mario
authors: M
authors: de Bellis
authors: Lorenzo
authors: L
authors: Fuccio
authors: Alessandro
authors: A
authors: Repici
authors: Enzo
authors: E
authors: Masci
authors: Sandro
authors: S
authors: Ardizzone
authors: Benedetto
authors: B
authors: Mangiavillano
authors: Alessandra
authors: A
authors: Carlino
authors: Giovanni Battista
authors: GB
authors: Rossi
authors: Pietro
authors: P
authors: Occhipinti
authors: Vincenzo
authors: V
authors: Cennamo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D008670:Metals