title: Comparison of through-the-scope stent insertion with standard stent insertion for the management of malignant colorectal obstruction: a prospective study.
abstract: BACKGROUND
  The aim of the present study was to compare the feasibility, safety and efficacy of the through-the-scope (TTS) stent technique to that of the standard metallic stent technique for the management of malignant colorectal obstruction.
  
  
  METHODS
  Fifty-two patients scheduled to receive stent insertion for the management of acute obstructive colorectal cancer were enrolled in our study and divided into a TTS stent group (n = 24) and a standard stent group (n = 28). The stent insertion procedure was performed under endoscopic and fluoroscopic guidance in all patients. The success rate, complications, fluoroscopic time, and clinical remission rate were recorded and compared.
  
  
  RESULTS
  The technique success rate was 100 % (24/24) in the TTS stent group and 78.6 % (22/28) in the standard stent group (p = 0.03). In five patients in the standard stent group, the stent failed to pass through occlusive lesions because of the stiffness of the stent system. Serious bleeding occurred in one patient in the standard stent group. The fluoroscopy time in the TTS stent group was significantly reduced (12.9 ± 6.6 min) compared with that of the standard stent group (24.8 ± 9.8 min; p < 0.01). Silent perforation occurred in 17.9 % (5/28) of the cases in the standard stent group compared with none in the TTS (p = 0.03). Clinical remission was achieved in 97.1 % (23/24) and 78.6 % (22/28) of patients in the TTS and standard stent groups, respectively (p = 0.11).
  
  
  CONCLUSIONS
  The TTS stent is safer and more feasible for the management of malignant colorectal obstructions than the standard stent, and the TTS technique provides a higher success rate, a similar clinical remission rate, and a markedly reduced fluoroscopic time.
authors.affiliation: Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China.|Department of Oncology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wan
authors.affiliation: Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China. zhuyueqi@hotmail.com.
authors.forename: Y-Q
authors.initials: YQ
authors.lastname: Zhu
authors.affiliation: Department of Gastroenterology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: N-W
authors.initials: NW
authors.lastname: Chen
authors.affiliation: Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Z-G
authors.initials: ZG
authors.lastname: Wang
authors.affiliation: Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China.
authors.forename: Y-S
authors.initials: YS
authors.lastname: Cheng
authors.affiliation: Department of Hematology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China. shijunsl@126.com.
authors.forename: J
authors.initials: J
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000295:instrumentation* / Q000379:methods; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D012074:Remission Induction / Q000379:methods; D015607:Stents; D016896:Treatment Outcome
keywords: Colorectal cancer; Fluoroscopic time; Occlusion; Stent