title: Endoscopic stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery.
abstract: BACKGROUND
  Although self-expandable metal stent (SEMS) insertion has been shown to be an effective therapy for palliation of obstruction from colorectal malignancy, the clinical efficacy of SEMS insertion in the palliation of colorectal obstruction from an extracolonic malignancy (ECM) has not been extensively evaluated.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the clinical outcomes and complications of SEMSs compared with those of emergency surgery for relief of colorectal obstruction in patients with advanced gastric cancer (AGC).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  From January 2000 to December 2009, patients with AGC who were treated with SEMSs (N = 111) or emergency surgery (N = 69) for palliation of malignant colorectal obstruction were included.
  
  
  METHODS
  SEMS insertion or surgery.
  
  
  RESULTS
  Although acute complications and stoma formations were lower in the SEMS group than in the surgery group, the clinical efficacy of SEMSs was inferior to emergency surgery (technical success, 73.9% vs 94.2%, P = .001; clinical success, 54.1% vs 75.4%, P = .005). SEMS-related complications occurred in 64.5%, including reobstruction (36.8%), stent migration (10.5%), perforation (13.2%), and bleeding (3.9%). The median duration of patency was not statistically different between the patients who underwent SEMS insertion and those who underwent emergency surgery (117 days vs 183 days, P = .105). Patients with fewer than 2 obstructive sites or less than 2 years to obstructive symptom onset after diagnosis of AGC showed better clinical outcomes after endoscopic stenting.
  
  
  CONCLUSIONS
  Retrospective and single-center study.
  
  
  CONCLUSIONS
  SEMS insertion seems to be less effective than emergency surgery for the palliation of colorectal obstruction in patients with AGC. Further study is necessary to define those patients with ECM who may benefit from SEMS insertion.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Bo Kyung
authors.initials: BK
authors.lastname: Kim
authors.forename: Sung Pil
authors.initials: SP
authors.lastname: Hong
authors.forename: Hyun Mi
authors.initials: HM
authors.lastname: Heo
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Hyuk
authors.initials: H
authors.lastname: Hur
authors.forename: Kang Young
authors.initials: KY
authors.lastname: Lee
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cheon
authors.forename: Tae Il
authors.initials: TI
authors.lastname: Kim
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003110:Colonic Neoplasms / Q000150:complications / Q000556:secondary*; D004630:Emergencies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D007416:Intestinal Perforation / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010166:Palliative Care / Q000379:methods*; D011475:Prosthesis Failure; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000473:pathology*; D016896:Treatment Outcome; D055815:Young Adult