The Effectiveness of Self-Expandable Metallic Stent Insertion in Treating Right-Sided Colonic Obstruction: A Comparison between SEMS and Decompression Tube Placement and an Investigation of the Safety and Difficulties of SEMS Insertion in Right Colons

Objectives.Self-expandable metallic stent (SEMS) is widely used to treat malignant colonic obstruction. However, most reports about SEMS insertion have concentrated on the left colon. This study aimed to (1) investigate the effectiveness of SEMS insertion compared with conventional decompression tube for right-sided colonic obstruction and (2) compare the safety and technical success of SEMS insertion between left- and right-sided colonic obstructions.Methods.The data from thirty-seven patients who underwent SEMS or conventional decompression tube placement for malignant colonic obstruction in our hospital were analyzed retrospectively. Technical and clinical success, complications, and technical difficulties were analyzed. We compared the results between SEMS insertion and decompression tube placement in right colons and the outcomes of SEMS insertion between right- and left-sided colonic obstructions.Results.For right colons, the clinical success rate of SEMS insertion (100%) was significantly higher than that of decompression tube placement (55.9%). Concerning SEMS insertion, the technical difficulty and safety of SEMS insertion were similar between right- and left-sided colonic obstructions.Conclusion.SEMS insertion for right-sided colon is significantly more effective than conventional decompression tube placement, and this procedure was safer and less technically challenging than expected. SEMS insertion should be considered for treating right-sided malignant colonic obstruction.

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Endoscopic Self-Expandable Metallic Stent Insertion without Fluoroscopic Guidance Is Feasible and Safe for Acute Colonic Obstruction Caused by Colorectal Cancer

Gastroenterology Research and Practice ◽

10.1155/2020/6810164 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Yadong Feng ◽

Qian Yu ◽

Ming Li ◽

Wei Xu ◽

Ye Zhu ◽

...

Keyword(s):

Success Rate ◽

Clinical Success ◽

Colonic Obstruction ◽

Clinical Success Rate ◽

Metallic Stent ◽

Fluoroscopic Guidance ◽

Procedure Time ◽

Technical Success ◽

Short Term ◽

Expandable Metallic Stent

Aims. Endoscopic self-expandable metallic stent (SEMS) insertion for acute colonic obstruction caused by colorectal cancer (CRC) is always performed under fluoroscopic guidance. This study evaluated the feasibility and safety of an endoscopic stenting procedure without fluoroscopic guidance. Methods. A total of 36 patients with an acute colonic obstruction caused by CRC underwent endoscopic SEMS insertion using a colonoscope without fluoroscopic guidance, followed by analyses of the technical and clinical success and short-term complications. Results. Total technical success rate and clinical success rate were 91.7% and 86.1%, respectively. The mean procedure time was 21.2±10.3 minutes. There was no stent dislodgement. One case of hematochezia and two cases of tenesmus occurred in patients with left-sided complete obstructions. No other short-term complications occurred. Procedure time, technical success, and clinical success rate were 16.3±9.4 minutes, 93.1%, and 89.6% for left-sided obstructions, respectively, and were 26.8±10.7 minutes, 85.7%, and 71.4% for right-sided obstructions, respectively. For complete obstructions, procedure time, technical success, and clinical success rate were 22.5±8.9 minutes, 90%, and 83.3%, respectively. In the incomplete cases, procedure time, technical success, and clinical success were 13.5±6.7 minutes, 100%, and 100%, respectively. Technical success, clinical success, and short-term complications were not differed between lesion locations and degrees. Conclusions. This simple technique is feasible and safe for palliation of acute colonic obstruction caused by CRC.

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Clinical benefits and oncologic equivalence of self-expandable metallic stent insertion for right-sided malignant colonic obstruction

Surgical Endoscopy ◽

10.1007/s00464-016-4946-2 ◽

2016 ◽

Vol 31 (1) ◽

pp. 153-158 ◽

Cited By ~ 10

Author(s):

Woong Bae Ji ◽

Jung Myun Kwak ◽

Dong Woo Kang ◽

Han Deok Kwak ◽

Jun Won Um ◽

...

Keyword(s):

Colonic Obstruction ◽

Stent Insertion ◽

Metallic Stent ◽

Expandable Metallic Stent ◽

Malignant Colonic Obstruction ◽

Clinical Benefits

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Factors related to difficult self‐expandable metallic stent placement for malignant colonic obstruction: A post‐hoc analysis of a multicenter study across Japan

Digestive Endoscopy ◽

10.1111/den.13260 ◽

2018 ◽

Vol 31 (1) ◽

pp. 51-58 ◽

Cited By ~ 10

Author(s):

Toshio Kuwai ◽

Toshiki Yamaguchi ◽

Hiroki Imagawa ◽

Shuntaro Yoshida ◽

Hiroyuki Isayama ◽

...

Keyword(s):

Multicenter Study ◽

Stent Placement ◽

Colonic Obstruction ◽

Metallic Stent ◽

Post Hoc Analysis ◽

Expandable Metallic Stent ◽

Malignant Colonic Obstruction ◽

Post Hoc ◽

Metallic Stent Placement

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Oncologic Outcomes of Self-Expandable Metallic Stent as a Bridge to Surgery and Safety and Feasibility of Minimally Invasive Surgery for Acute Malignant Colonic Obstruction

Annals of Surgical Oncology ◽

10.1245/s10434-019-07346-3 ◽

2019 ◽

Vol 26 (9) ◽

pp. 2787-2796 ◽

Cited By ~ 12

Author(s):

Seung Yoon Yang ◽

Youn Young Park ◽

Yoon Dae Han ◽

Min Soo Cho ◽

Hyuk Hur ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Colonic Obstruction ◽

Oncologic Outcomes ◽

Metallic Stent ◽

Bridge To Surgery ◽

Expandable Metallic Stent ◽

Malignant Colonic Obstruction

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Fluoroscopic Stenting as a Bridge to Surgery versus Emergency Management for Malignant Obstruction of the Colon

Emergency Medicine International ◽

10.1155/2020/4650780 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Fan Xue ◽

Feng Lin ◽

Jun Zhou ◽

Ning Feng ◽

You-Gang Cui ◽

...

Keyword(s):

Emergency Surgery ◽

Clinical Success ◽

Colonic Obstruction ◽

Laparoscopic Approach ◽

Metallic Stent ◽

Bridge To Surgery ◽

Success Rates ◽

Clinicopathologic Characteristics ◽

Sems Group ◽

Malignant Colonic Obstruction

Aim. To investigate the feasibility of a SEMS (self-expandable metallic stent) as a bridge to surgery for malignant colonic obstruction. Methods. We retrospectively reviewed 83 patients that were in accordance with inclusion criteria; of these, 33 patients that underwent fluoroscopy-guided SEMS placement followed by elective curative resection were classified as a SEMS group and 50 patients, who received emergency surgery (ES), were classified as an ES group. The clinicopathological characteristics, surgery-related parameters, complications, and three-year survival rate were compared between the two groups. Results. No significant differences between the two groups were observed in any of the clinicopathologic characteristics except for higher preoperative absolute neutrophil count in the ES group (P<0.001). Compared to the ES group, the SEMS group has significantly more cases, which featured a laparoscopic approach (72.7% vs. 14.0%, P<0.001), lower overall stoma rate (0% vs. 34.0%, P<0.001), and lower overall postoperative morbidity (27.3% vs. 56.0%, P=0.010). The oncological outcomes did not differ significantly between the two groups in terms of three-year overall survival (P=0.125). The technical and clinical success rates of stent placement were 91.7% and 100%, respectively. Conclusion. Patients treated with the stent-surgery approach had significant short-term superiorities and similar long-term outcomes, compared to patients who had emergency surgery alone. The SEMS is, therefore, safe and feasible as a bridge to surgery for malignant colonic obstruction.

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Is a small-caliber or large-caliber endoscope more suitable for colonic self-expandable metallic stent placement? A randomized controlled study

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211065331 ◽

2022 ◽

Vol 15 ◽

pp. 175628482110653

Author(s):

Yosuke Minoda ◽

Haruei Ogino ◽

Yorinobu Sumida ◽

Takashi Osoegawa ◽

Soichi Itaba ◽

...

Keyword(s):

Success Rate ◽

Colonic Obstruction ◽

Clinical Success Rate ◽

Insertion Time ◽

University Hospital ◽

Controlled Study ◽

Metallic Stent ◽

Procedure Time ◽

Sems Placement ◽

Expandable Metallic Stent

Objectives: The colonic self-expandable metallic stent (C-SEMS) with a 9-French (Fr) delivery system allows for a small-caliber endoscope (SCE) to be used to treat malignant colonic obstruction. Despite the lack of evidence, the SCE has become popular because it is considered easier to insert than the large-caliber endoscope (LCE). We aimed to determine whether the SCE is more suitable than the LCE for C-SEMS placement. Methods: Between July 2018 and November 2019, 50 consecutive patients who were scheduled to undergo C-SEMS for colon obstruction were recruited in this study. Patients were randomized to the SCE or LCE group. The SCE and LCE were used with 9-Fr and 10-Fr delivery systems, respectively. The primary outcome was the total procedure time. Secondary outcomes were the technical success rate, complication rate, clinical success rate, insertion time, guidewire-passage time, stent-deployment time, and colonic obstruction-scoring-system score. Results: Forty-five patients (SCE group, n = 22; LCE group, n = 23) were analyzed. The procedure time in the LCE group (median, 20.5 min) was significantly ( p = 0.024) shorter than that in the SCE group (median, 25.1 min). The insertion time in the LCE group (median, 2.0 min) was significantly ( p = 0.0049) shorter than that in the SCE group (median, 6.0 min). A sub-analysis of the procedure difficulties showed that the insertion time in the LCE group (median, 5.0 min) was significantly shorter than that in the SCE group (median, 8.5 min). Conclusion: Both LCE and SCE can be used for C-SEMS; however, LCE is more suitable than SCE as it achieved a faster and equally efficacious C-SEMS placement as that of SCE. Clinical trial registration number: University Hospital Medical Information Network Clinical Trials Registry (UMIN 32748)

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