title: Favorable long-term clinical outcome of uncovered D-weave stent placement as definitive palliative treatment for malignant colorectal obstruction.
abstract: BACKGROUND
  Most self-expandable metallic stents for colorectal placement are uncovered because of the high migration rate of covered stents. However, the optimal stent design for colorectal use remains unclear.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the efficacy and safety of a double-wire woven uncovered stent for definitive palliative treatment of malignant colorectal obstruction.
  
  
  METHODS
  This study was a prospective, single-arm, observational clinical study of patients enrolled between December 2005 and September 2010.
  
  
  METHODS
  This study was conducted at a referral hospital in Japan.
  
  
  METHODS
  Twenty-four consecutive patients with malignant colorectal obstruction were included in the study.
  
  
  METHODS
  A double-wire woven uncovered stent was placed by use of a standard through-the-scope endoscopic placement technique.
  
  
  METHODS
  Technical, initial clinical, and long-term clinical success were measured. Long-term clinical success was defined as sustained relief of obstructive symptoms without reintervention until the patient's death.
  
  
  RESULTS
  The Karnofsky performance status score before stent placement was 60 (median, interquartile range, 42.5-67.5). Twenty of 24 patients had primary colorectal cancer, and 4 had extracolorectal malignancies. The site of obstruction was the ascending colon in 10 patients, descending colon in 4 patients, sigmoid colon in 7 patients, and rectum in 3 patients. Technical, initial, and long-term clinical success rates were 100%, 100%, and 83%. Median stent patency time was 149 days (interquartile range, 45-198 days). Median survival time after stent placement was 155 days (interquartile range, 68-231 days). Four patients (17%) had negative outcomes including stent occlusion by tumor ingrowth (8%) and stent migration (8%). The highest Karnofsky performance status score after stent placement was 70 (median; interquartile range, 50-70). The Karnofsky performance status score improved after stent placement (p = 0.002).
  
  
  CONCLUSIONS
  This study was limited because it was a single-arm, single-center study, and it had a small sample size.
  
  
  CONCLUSIONS
  Endoscopic placement of double-wire woven uncovered stents is effective and safe as definitive palliative treatment for patients with malignant colorectal obstruction.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tominaga
authors.forename: Iruru
authors.initials: I
authors.lastname: Maetani
authors.forename: Koichiro
authors.initials: K
authors.lastname: Sato
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shigoka
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Omuta
authors.forename: Sayo
authors.initials: S
authors.lastname: Ito
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Saigusa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D008297:Male; D010166:Palliative Care; D011446:Prospective Studies; D019919:Prosthesis Implantation; D015607:Stents; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents