What is the necessity of endoscopist for successful endoscopic stenting in patients with malignant colorectal obstruction?
OBJECTIVE
Recently, self-expandable metal stents (SEMSs) have been widely used as an initial therapy for relieving malignant colorectal obstructions. However, several factors, including the endoscopist's experience, affect the clinical outcome of SEMSs. The aim of this study was to define the adequate level of experience necessary to perform endoscopic stenting effectively and safely and to identify technical factors for successful stenting.


METHODS
Between March 2009 and June 2012, 160 patients underwent SEMS placement for malignant colorectal obstruction with the intent of palliation or as a bridge to surgery by a single endoscopist who experienced colonoscopy and endoscopic retrograde cholangiopancreatography.


RESULTS
The overall technical and clinical success rates were 86.9 and 86.4%, respectively, and 18 complications (11.3%) were observed. There were no differences in any of the clinical outcomes between the consecutive blocks; however, the procedure time decreased significantly after the first 30 procedures (17.4, 16.9, 13.5, and 12.8 min; P = 0.044). American Society of Anesthesiologists (ASA) class, history of a previous operation, proximal colon obstruction, obstruction caused by an extracolonic malignancy, and palliative SEMS placement were associated with technical failure.


CONCLUSIONS
An endoscopist who experiences a colonoscopy and fluoroscopy performs SEMS placement successfully regardless of the level of experience. After the first 30 procedures, a SEMS insertion could be safely and effectively performed with short procedure time in patients with malignant colorectal obstruction.
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yensei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
Hyun Jung
HJ
Lee
Soo Jung
SJ
Park
Jae Hee
JH
Cheon
Tae Il
TI
Kim
Won Ho
WH
Kim
Sung Pil
SP
Hong
D000368:Aged; D002983:Clinical Competence; D015179:Colorectal Neoplasms / Q000150:complications*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010166:Palliative Care; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents