The Principles of Situational Control SEMS Group

AbstractChronic pancreatitis (CP) related main pancreatic duct (MPD) stricture has been a challenge for endoscopists. Fully covered self-expandable metal stents (FC-SEMS) has been tried in CP patients, but the efficacy and safety are still controversial. Thus, we aim to compare the long-term clinical efficacy of FC-SEMS vs. plastic stent placement in persistent MPD strictures secondary to CP. Between 2007 and 2018, 80 chronic pancreatitis patients (58 males, median age 49 years), who underwent endoscopic placement of FC-SEMS (n = 26) and plastic stent (n = 54) for persistent MPD strictures after at least 3 months of initial single plastic stenting, were retrospectively analyzed during a median follow-up duration of 33.7 months. As a result, MPD stricture resolution rate was statistically higher in FC-SEMS group (87.0% vs. 42.0%, p < 0.001). Although immediate complications occurred similarly (38.5% vs. 37.0%, p = 0.902), spontaneous migration (26.9%) and de novo strictures (23.1%) were pronounced delayed complications in FC-SEMS group. Pain relief during follow-up was significantly higher in FC-SEMS group (76.9% vs. 53.7%, p = 0.046). The total procedure cost was similar in both groups ($1,455.6 vs. $1,596.9, p = 0.486). In comparison with plastic stent, FC-SEMS placement for persistent MPD strictures had favorable long-term clinical efficacy, with its typical complications like spontaneous migration and de novo strictures.

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Evaluation of post-ERCP pancreatitis after biliary stenting with self-expandable metal stents vs. plastic stents in benign and malignant obstructions

Endoscopy International Open ◽

10.1055/a-1388-6964 ◽

2021 ◽

Vol 09 (06) ◽

pp. E888-E894

Author(s):

Nichol S. Martinez ◽

Sumant Inamdar ◽

Sheila N. Firoozan ◽

Stephanie Izard ◽

Calvin Lee ◽

...

Keyword(s):

Pancreatic Duct ◽

Medical Center ◽

Tertiary Care ◽

Plastic Stents ◽

Metal Stents ◽

Limited Data ◽

Sems Group ◽

Tertiary Care Medical Center ◽

Stent Type ◽

Pancreatic Duct Stent

Abstract Background and study aims There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions. Patients and methods A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Results Among the 1136 patients included in our study, 399 had SEMS placed and 737 had PS placed. Patients with PS were more likely to have pancreatic duct cannulation, pancreatic duct stent placement, double guidewire technique, sphincterotomy and sphincteroplasty as compared to the SEMS group. On multivariate analysis, PEP rates were higher in the SEMS group (8.0 %) versus the PS group (4.8 %) (OR 2.27 [CI, 1.22, 4.24]) for all obstructions. For malignant obstructions, PEP rates were 7.8 % and 6.6 % for SEMS and plastic stents, respectively (OR 1.54 [CI, 0.72, 3.30]). For benign obstructions the PEP rate was higher in the SEMS group (8.8 %) compared to the PS group (4.2 %) (OR 3.67 [CI, 1.50, 8.97]). No significant differences between PEP severity were identified based on stent type when stratified based on benign and malignant. Conclusions PEP rates were higher when SEMS were used for benign obstruction as compared to PS. For malignant obstruction, no difference was identified in PEP rates with use of SEMS vs PS.

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Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

BMC Surgery ◽

10.1186/s12893-020-00908-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yang Hu ◽

Jiajun Fan ◽

Yifan Xv ◽

Yingjie Hu ◽

Yuan Ding ◽

...

Keyword(s):

Colorectal Cancer ◽

Emergency Surgery ◽

Meta Analysis ◽

Metal Stents ◽

Bridge To Surgery ◽

Sems Group ◽

Obstructive Colorectal Cancer ◽

Significant Difference ◽

Self Expanding Metal Stents

Abstract Background To explore the long-term oncological safety of using self-expanding metal stents (SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery (ES) with elective surgery after the placement of SEMS. Methods Studies comparing SEMS as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated for the outcomes under random effects model. Results A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence of perineural invasion (RR = 0.58, 95% CI 0.48, 0.71, P < 0.00001), lymphovascular invasion (RR = 0.68, 95% CI 0.47, 0.99, P = 0.004) and vascular invasion (RR = 0.66, 95% CI 0.45, 0.99, P = 0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion (RR = 0.92, 95% CI 0.77, 1.09, P = 0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group (MD = − 3.18, 95% CI − 4.47, − 1.90, P < 0.00001). While no significant difference was found in the number of positive lymph nodes (MD = − 0.11, 95% CI − 0.63, 0.42, P = 0.69) and N stage [N0 (RR = 1.03, 95% CI 0.92, 1.15, P = 0.60), N1 (RR = 0.99, 95% CI 0.87, 1.14, P = 0.91), N2 (RR = 0.94, 95% CI 0.77, 1.15, P = 0.53)]. Conclusions SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, their adverse effects cannot be ignored. The use of SEMS as the preferred treatment for patients with resectable obstructive colorectal cancer remains to be carefully weighed, especially when patients are young or the surgical risk is not very high.

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Outcome comparison between bridge to surgery stenting and emergency surgery in stage II, III obstructive left colon cancer: A multicenter retrospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.747 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 747-747

Author(s):

Han-mo Yoo ◽

Won-Kyung Kang

Keyword(s):

Colon Cancer ◽

Emergency Surgery ◽

Disease Free Survival ◽

Left Colon ◽

Stage Ii ◽

Stage Iii ◽

Free Survival ◽

Sems Group ◽

Left Colon Cancer ◽

Disease Free

747 Background: A SEMS (Self Expandable Metallic Stents) has been widely used for obstructive colorectal cancer as a bridge to surgery to avoid emergency surgery. However, it may increase the tumor spillage so that the long-term survival would be compromised. The aim of our study was to compare the short- and long-term outcome of surgery after stent insertion with those of emergency surgery alone for the left colon malignant obstruction patients. Methods: The medical records of patients who received curative resection due to obstructive primary left colon cancer and diagnosed to stage II or III from January 2004 to December 2010 in six hospitals affiliated to the Catholic Medical Center. Overall survival and disease free survival were compared between the SEMS (n = 158) and emergency surgery (n = 56) group. Short-term outcome was also compared. Factors affecting disease-free survival in the SEMS group were analyzed using the cox proportional hazards model. Results: Baseline characteristics were comparable between two groups by pathologic stage. Intra-operative complication (0.0% vs. 7.1%, p = 0.004), re-operation (1.3% vs. 7.1%, p = 0.042), post-operative hospital stay (11.2 ± 6.5 days vs. 14.6 ± 8.9 days, p = 0.010) and conversion rate (3.5% vs. 16.7%, p = 0.028) showed short-term advantages of the SEMS. 5-year DFS in stage II patients was 87.2% for the SMES group, 73.5% for the ES group (p = 0.117). Among stage III patients, 5-year DFS was 55.8% for the SEMS group and 72.0% for the ES group (p = 0.129). 5-year OS of the SEMS group was 90.2%, and of the ES group was 92.4% in stage II patients (p = 0.694). 5-year OS in the SEMS group was 82.8%, and the ES group 73.0% in stage III patients (p = 0.577). For the stage III SEMS patients, hospital of procedure (p = 0.041) and operation date (HR 0.400, 95% C.I 0.176-0.905, p = 0.028) were independent factors on disease free survival. Conclusions: If there’s an intervention team with sufficient experience for the SEMS and a sufficient preparation for emergency surgery, the SEMS is a good therapeutic option for malignant obstruction in left colon cancer.

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Comparison on the Efficacy between Partially Covered Self-Expandable Metal Stent with Funnel-Shaped Enlarged Head versus Uncovered Self-Expandable Metal Stent for Palliation of Gastric Outlet Obstruction

Gastroenterology Research and Practice ◽

10.1155/2018/4540138 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Jung Wan Choe ◽

Jong Jin Hyun ◽

Dong-won Lee ◽

Sang Jun Suh ◽

Seung Young Kim ◽

...

Keyword(s):

Success Rate ◽

Gastric Outlet Obstruction ◽

Outlet Obstruction ◽

Clinical Success Rate ◽

Metal Stent ◽

Stent Patency ◽

Advanced Malignancy ◽

Sems Group ◽

Distal Migration ◽

Self Expandable Metal Stent

Background. Shape modification has been one of the methods adopted to improve stent patency but has not always translated into positive outcome. The aim of this study was to compare the efficacy of shape-modified partially covered self-expandable metal stent (SEMS) that has enlarged head versus uncovered SEMS for palliation of gastric outlet obstruction (GOO). Methods. A total of 48 patients underwent insertion of either enlarged-head SEMS (n=24) or uncovered SEMS (uSEMS) (n=24) for palliation of GOO from July 2009 to July 2016. Patients with inoperable or advanced malignancy were included. Technical feasibility and clinical outcomes were compared. Results. Technical success rate was 100% (24/24) and 95.8% (23/24) for enlarged-head SEMS group and uSEMS group, respectively. Clinical success rate was 87.5% (21/24) and 87.0% (20/23) for enlarged-head SEMS group and uSEMS group, respectively. The gastric outlet obstruction scoring system score significantly improved in both groups (p<0.001 for both). Mean survival was similar between the groups: enlarged-head SEMS group, 99.3 days (range, 19–358 days) versus uSEMS group, 82.1 days (range, 11–231 days) (p=0.418). The mean stent patency also showed no difference between the groups: enlarged-head SEMS group, 87.1 days (range, 8–358 days) versus uSEMS group, 60.4 days (range, 2–231 days) (p=0.204). With enlarged-head SEMS, distal migration did not occur, but proximal migration was observed in four cases. Conclusions. Distal migration was prevented by shaping the SEMS to have an enlarged head, but improvement in stent patency could not be observed.

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Comparison of three kinds of self-expandable metallic stents induced granulation tissue hyperplasia in the rabbit trachea

Scientific Reports ◽

10.1038/s41598-021-02573-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yahua Li ◽

Mengde Li ◽

Xiaofeng Wang ◽

Yuhui Wang ◽

Chang Li ◽

...

Keyword(s):

Computed Tomography ◽

Granulation Tissue ◽

Stent Placement ◽

Radial Force ◽

Area Ratio ◽

Metallic Stents ◽

Sems Group ◽

Papillary Projection ◽

Epithelial Layers ◽

Expandable Metallic Stents

AbstractTo compare stent-induced granulation tissue hyperplasia of bare (SEMS), polyurethane-covered (PU-SEMS) and electrospun nanofibre-covered (EN-SEMS) self-expandable metallic stents in the rabbit trachea. Twenty-seven rabbits were randomly assigned to 3 groups that received SEMS, PU-SEMS or EN-SEMS. Computed tomography and sacrifice were performed as scheduled. Haematoxylin–eosin and Masson’s trichrome staining protocols were performed for pathological analysis. The data for tracheal ventilation area ratio, qualitative histological scoring, number of epithelial layers, and thicknesses of papillary projection and submucosa were documented and statistically analysed. All stents were successfully placed under the guidance of fluoroscopy without complications. Post-stenting 3 and 7 days, computed tomography revealed that the fully expandable EN-SEMS was similar to the SEMS and PU-SEMS. The mean stented tissue score in the SEMS group was higher than those of both the PU-SEMS and EN-SEMS groups at 3 days post-stenting. The pathological findings suggested that there was no papillary projection formation 3 days after stent placement. The thickness of papillary projection in the SEMS group was significantly higher than those of the PU-SEMS and EN-SEMS groups at 7 days post-stenting. After stenting 4 weeks, the tracheal ventilation area ratio of SEMS, PU-SEMS and EN-SEMS was 0.214 ± 0.021, 0.453 ± 0.028 and 0.619 ± 0.033, respectively. There were significant between-group differences. In conclusion, the stent-induced granulation tissue formation in EN-SEMS is less severe than that of PU-SEMS and SEMS. EN-SEMS has smaller radial force, and the tracheal ventilation ratio after stent placement better than that of PU-SEMS.

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Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

10.21203/rs.3.rs-43717/v3 ◽

2020 ◽

Author(s):

Yang Hu ◽

Jiajun Fan ◽

Yifan Xv ◽

Yingjie Hu ◽

Yuan Ding ◽

...

Keyword(s):

Colorectal Cancer ◽

Emergency Surgery ◽

Meta Analysis ◽

Metal Stents ◽

Bridge To Surgery ◽

Sems Group ◽

Obstructive Colorectal Cancer ◽

Significant Difference ◽

Self Expanding Metal Stents

Abstract Background: To explore the long-term oncological safety of using self-expanding metal stents(SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery(ES) with elective surgery after the placement of SEMS.Methods: Studies comparing SEMS as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios(OR) or mean differences(MD) with 95% confidence intervals(CI) were calculated for the outcomes under random effects model.Results: A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence of perineural invasion(RR=0.58, 95% CI=0.48, 0.71, P<0.00001), lymphovascular invasion(RR=0.68, 95%CI=0.47,0.99, P=0.004) and vascular invasion(RR=0.66, 95%CI=0.45,0.99, P=0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion(RR=0.92, 95%CI=0.77,1.09, P=0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group(MD=-3.18, 95% CI=-4.47,-1.90, P<0.00001). While no significant difference was found in the number of positive lymph nodes(MD=-0.11, 95%CI=-0.63,0.42, P=0.69) and N stage[N0(RR=1.03, 95%CI=0.92,1.15, P=0.60), N1(RR=0.99, 95%CI=0.87,1.14, P=0.91), N2(RR=0.94, 95%CI=0.77,1.15, P=0.53)]. Conclusions: SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, their adverse effects cannot be ignored. The use of SEMS as the preferred treatment for patients with resectable obstructive colorectal cancer remains to be carefully weighed, especially when patients are young or the surgical risk is not very high.

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Self-expandable metallic stenting as a bridge to elective surgery versus emergency surgery for acute malignant right-sided colorectal obstruction

10.21203/rs.3.rs-33526/v2 ◽

2020 ◽

Author(s):

Bing Li ◽

Shi-Lun Cai ◽

Zhen-Tao Lv ◽

Ping-Hong Zhou ◽

Li-Qing Yao ◽

...

Keyword(s):

Liver Metastases ◽

Emergency Surgery ◽

Elective Surgery ◽

Primary Tumour ◽

Stage Iv ◽

Sems Placement ◽

Short Term ◽

Synchronous Liver Metastases ◽

Sems Group ◽

Significant Difference

Abstract Background: The use of a self-expandable metallic stent (SEMS) as a bridge to surgery has increased for patients with obstructing colorectal cancer. However, relatively few reports have compared SEMS as a bridge to elective surgery for acute malignant obstruction of the right-sided colon (MORC) vs. emergency surgery (ES). This study aimed to evaluate the benefits of elective surgery after SEMS placement vs. ES for patients (including stage IV cases) with acute MORC.Methods: Patients with acute MORC who underwent radical resection for a primary tumour from July 2008 to November 2016 at Zhongshan Hospital of Fudan University were retrospectively enrolled. Postoperative short-term outcomes, progression-free survival (PFS), and overall survival (OS) were compared between the SEMS and ES groups.Results: In total, 107 patients with acute MORC (35 in the SEMS group and 72 in the ES group) were included for analysis. The Intensive Care Unit admission rate was lower (11.4% vs. 34.7%, P = 0.011), the incidence of complications was reduced (11.4% vs. 29.2%, P = 0.042), and the postoperative length of hospitalisation was significantly shorter (8.23 ± 6.50 vs. 11.18 ± 6.71 days, P = 0.033) for the SEMS group. Survival curves showed no significant difference in PFS (P = 0.506) or OS (P = 0.989) between groups. Also, there was no significant difference in PFS and OS rates between patients with stage II and III colon cancer. After colectomy for synchronous liver metastases among stage IV patients, the hepatectomy rates for the SEMS and ES groups were 85.7% and 14.3%, respectively (P = 0.029). The hazard ratio for colectomy alone vs. combined resection was 3.258 (95% CI 0.858–12.370; P = 0.041).Conclusion: Stent placement offers significant advantages in terms of short-term outcomes and comparable prognoses for acute MORC patients. For synchronous liver metastases, SEMS placement better prepares the patient for resection of the primary tumour and liver metastasis, which contribute to improved survival.

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Colonic Stent Placement May Reduce Mortality Rate and Length of Hospitalization in Obstructive Colorectal Cancer Cases: a Propensity Score-matched Analysis Using a Nationwide Database in Japan

10.21203/rs.3.rs-864898/v1 ◽

2021 ◽

Author(s):

Rintaro Moroi ◽

Kunio Tarasawa ◽

Yusuke Shimoyama ◽

Masatake Kuroha ◽

Hisashi Shiga ◽

...

Keyword(s):

Colorectal Cancer ◽

Mortality Rate ◽

Propensity Score ◽

Propensity Score Matching ◽

Medical Costs ◽

Hospital Death ◽

Sems Group ◽

Obstructive Colorectal Cancer ◽

Urgent Surgery ◽

Length Of Hospitalization

Abstract Background and aims: Self-expandable metallic stent (SEMS) is widely used for obstructive colorectal cancer (OCC). Both SEMS and urgent surgery have several merits and demerits. This study aimed to clarify the efficacy of SEMS by comparing the mortality rate after the hospitalization between SEMS and urgent surgery for OCC.Methods: We collected OCC patients’ data using the Diagnosis Procedure Combination (DPC) database system. We divided eligible patients into the SEMS and urgent surgery groups using propensity score matching, and compared in-hospital death rates, length of hospitalization, and medical costs. We also conducted logistic regression analysis to identify clinical factors affecting in-hospital deaths.Results: We enrolled 17,140 cases after propensity score matching. SEMS reduced the in-hospital death rate compared to urgent surgery (2.0% vs. 3.6%, P < 0.0001). Length of hospitalization was shorter in the SEMS group than in the urgent surgery group (16 vs. 25 days, P < 0.0001). Medical costs were lower in the SEMS group than in the urgent surgery group (1,663,550 vs. 2,424,082 JPY, P < 0.0001). Multivariate analysis also showed that SEMS reduced in-hospital death (odds ratio = 0.58, 95% confidence interval: 0.50‒0.70, P < 0.0001).Conclusion: SEMS placement for OCC could reduce the mortality rate and shorten the length of hospitalization. These results facilitate considering SEMS with careful judgement for its indication when treating OCC patients.

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Comparison of safety between self-expanding metal stents as a bridge to surgery and emergency surgery based on pathology: a meta-analysis

10.21203/rs.3.rs-43717/v2 ◽

2020 ◽

Author(s):

Yang Hu ◽

Jiajun Fan ◽

Yifan Xv ◽

Yingjie Hu ◽

Yuan Ding ◽

...

Keyword(s):

Colorectal Cancer ◽

Emergency Surgery ◽

Meta Analysis ◽

Metal Stents ◽

Bridge To Surgery ◽

Sems Group ◽

Obstructive Colorectal Cancer ◽

Significant Difference ◽

Self Expanding Metal Stents

Abstract Background: To explore the long-term oncological safety of using self-expanding metal stents(SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery(ES) with elective surgery after the placement of SEMS. Methods: Studies comparing SMES as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios(OR) or mean differences(MD) with 95% confidence intervals(CI) were calculated for the outcomes under random effects model. Results: A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence ofperineural invasion(RR=0.58, 95% CI=0.48, 0.71, P<0.00001), lymphovascular invasion(RR=0.68, 95%CI=0.47,0.99, P=0.004) and vascular invasion(RR=0.66, 95%CI=0.45,0.99, P=0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion(RR=0.92, 95%CI=0.77,1.09, P=0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group(MD=-3.18, 95% CI=-4.47,-1.90, P<0.00001). While no significant difference was found in the number of positive lymph nodes(MD=-0.11, 95%CI=-0.63,0.42, P=0.69) and N stage[N0(RR=1.03, 95%CI=0.92,1.15, P=0.60), N1(RR=0.99, 95%CI=0.87,1.14, P=0.91), N2(RR=0.94, 95%CI=0.77,1.15, P=0.53)]. Conclusions: SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, it should not be considered as the first treatment for radically resectable colorectal cancer.

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