Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 7, 2013; 19(41): 7138-7145
Published online Nov 7, 2013. doi: 10.3748/wjg.v19.i41.7138
Complications and survival in patients undergoing colonic stenting for malignant obstruction
Majid A Almadi, Nahla Azzam, Othman Alharbi, Alabbas H Mohammed, Nazia Sadaf, Abdulrahman M Aljebreen
Majid A Almadi, Nahla Azzam, Othman Alharbi, Alabbas H Mohammed, Nazia Sadaf, Abdulrahman M Aljebreen, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia
Majid A Almadi, Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, H3G 1A4, Canada
Author contributions: Almadi MA, Azzam N, Alharbi O, and Aljebreen AM all contributed towards the article’s conception and design, acquisition of data, drafting of the article, and final approval of the version to be published; Mohammed AH and Sadaf N contributed towards data collection, drafting and revising the article critically for important intellectual content, and final approval of the version to be published.
Supported by The Deanship of Scientific Research at King Saud University funded this research through the Research Group Project, No. RGP-VPP-279
Correspondence to: Majid A Almadi, MBBS, FRCPC, MSc, Assistant Professor of Medicine, Division of Gastroenterology, King Khalid University Hospital, King Saud University, P.O. Box 2925 (59), Riyadh 11461, Saudi Arabia. maalmadi@ksu.edu.sa
Telephone: +966-1-4679167 Fax: +966-1-4671217
Received: April 13, 2013
Revised: July 22, 2013
Accepted: August 4, 2013
Published online: November 7, 2013
Abstract

AIM: To investigate whether predicting patients that might be at a higher risk for complications might serve to improve the selection of patients undergoing colonic stenting.

METHODS: A retrospective review of consecutive patients who underwent an attempted self-expandable metal stent (SEMS) insertion for malignant colonic obstruction between November 2006 and March 2013. All patients were either referred for preoperative colonic decompression with the intent of a single surgical procedure, or for palliation of the malignant colorectal obstruction for unresectable cancer. Fisher’s test or χ2 test was performed on categorical variables, and the t test for continuous variables. Univariable and multivariable logistic regression were used to examine the association between independent variables and the presence of complications from SEMS insertion.

RESULTS: SEMS insertion was attempted in 73 patients. Males comprised 55.71% and the mean age was 67.41 ± 12.41 years. Of these, 65.15% underwent subsequent surgery, while 34.85% received SEMS as palliation for advanced disease. Extracolonic tumors were only 4.76%. The majority of patients had stage IV disease (63.83%), while the remainder had stage III (36.17%). SEMS were successfully inserted in 93.85% (95%CI: 87.85%-99.85%). Perforations occurred in 4.10%, SEMS migration in 8.21%, and stent re-occlusion from ingrowth occurred in 2.74% of patients. The mean duration of follow up for the patients was 13.52 ± 17.48 mo (range 0-73 mo). None of the variables: age, sex, time between the onset of symptoms to SEMS insertion, time between SEMS insertion and surgery, length of the stenosis, location of the stenosis, albumin level, or receiving neoadjuvant chemotherapy, could predict the development of complications from either SEMS insertion nor prolonged survival.

CONCLUSION: None of the variables could predict the development of complications or survival. Further studies are required to identify patients who would benefit the most from SEMS.

Keywords: Colonic obstruction, Colorectal cancer, Palliative interventions, Self-expanding metal stent, Colonic stents, Enteric stenting, Emergency surgery, Complications, Endoscopy

Core tip: Despite the debate as to whether there is an added benefit from the use of self-expandable metal stents (SEMS), when compared to surgery, as an initial management strategy in patients with malignant colorectal obstruction, this study found that SEMS insertion for malignant colonic obstruction is a safe option with an acceptable risk profile. We could not identify factors that would predict the development of complications or factors that might impact long-term survival. Nonetheless, based on current guidelines, SEMS insertion for malignant colorectal obstruction is the best option for palliation or as a bridge to surgery when technical skills for such a procedure are available.