title: Self-expanding metallic stent improves histopathologic edema compared with transanal drainage tube for malignant colorectal obstruction.
abstract: To compare the usefulness of the self-expanding metallic stent (SEMS) with that of the transanal drainage tube (TDT) and emergency surgery after failure of decompression (ESFD) in patients with malignant colonic obstruction (MCO), and to evaluate post-decompression histopathologic changes.
  
  
  
  From January 2010 to June 2015, 39 patients with MCO received SEMS, TDT, and ESFD. We evaluated the outcomes including success rates of placement, clinical outcomes after decompression, and histopathologic findings of the resected specimens.
  
  
  
  Technical success rates were 100% for SEMS and 78.9% for TDT. Clinical success rates were 100% for SEMS and 80.0% for TDT. Postoperative ileus was significantly less frequent after SEMS than after TDT (p = 0.014). Histopathologic edema grade was significantly lower for SEMS than for TDT and ESFD (p < 0.0001). There was no significant difference between edema grade and duration of decompression in the TDT group (p = 0.629), while all patients with SEMS were classified in a low edema grade (grade 0-2). The rate of stoma creation was significantly higher in patients with a high edema grade (grade 3) than in those with a low edema grade (grade 0-2) (p = 0.003). There was no microscopic perforation in any group.
  
  
  
  Significantly greater resolution of histopathologic edema was achieved after placement of SEMS than after placement of TDT. These findings provide an indication of favorable clinical outcomes of SEMS in comparison with TDT and ESFD. This article is protected by copyright. All rights reserved.
authors.affiliation: Department of Gastroenterological Surgery, Nara Hospital, Kinki University Faculty of Medicine.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takeyama
authors.affiliation: Department of Gastroenterological Surgery, Nara Hospital, Kinki University Faculty of Medicine.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Kitani
authors.affiliation: Department of Pathology, Nara Hospital, Kinki University Faculty of Medicine.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Wakasa
authors.affiliation: Department of Gastroenterological Surgery, Nara Hospital, Kinki University Faculty of Medicine.
authors.forename: Masanori
authors.initials: M
authors.lastname: Tsujie
authors.affiliation: Department of Gastroenterological Surgery, Nara Hospital, Kinki University Faculty of Medicine.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Fujiwara
authors.affiliation: Department of Endoscopy, Nara Hospital, Kinki University Faculty of Medicine.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Mizuno
authors.affiliation: Department of Gastroenterological Surgery, Nara Hospital, Kinki University Faculty of Medicine.
authors.forename: Masao
authors.initials: M
authors.lastname: Yukawa
authors.affiliation: Department of Pathology, Nara Hospital, Kinki University Faculty of Medicine.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ohta
authors.affiliation: Department of Gastroenterological Surgery, Nara Hospital, Kinki University Faculty of Medicine.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Inoue
keywords: colorectal cancer; emergency surgery; malignant colorectal obstruction (MCO); self-expanding metallic stent (SEMS); transanal drainage tube