Predictors of clinical outcome of colonic stents in patients with malignant large-bowel obstruction because of extracolonic malignancy Journal Article

Authors: Faraz, S.; Salem, S. B.; Schattner, M.; Mendelsohn, R.; Markowitz, A.; Ludwig, E.; Zheng, J.; Gerdes, H.; Shah, P. M.
Article Title: Predictors of clinical outcome of colonic stents in patients with malignant large-bowel obstruction because of extracolonic malignancy
Abstract: Background and Aims: Colonic stent placement in patients with large-bowel obstruction (LBO) secondary to extracolonic malignancy (ECM) has been evaluated in small series with heterogeneous results. Our aim is to better characterize the technical and clinical success of colonic stent placement and to identify factors that affect this success in ECM patients. Methods: All patients at a single high-volume center who presented for colonic stent placement for LBO because of ECM between 2001 and 2012 were retrospectively identified. The outcomes of interest were technical success, clinical success, stent occlusion rate, and overall survival. Results: A total of 187 patients were identified. Mean age was 61.9 years (range, 23-89), and 150 (80.2%) were women. The most common malignancy type was urogynecologic (n = 104) and most common location sigmoid colon (n = 128). Overall, 142 patients (75.9%) achieved technical success and 102 patients (54.5%) clinical success. Radiographic presence of peritoneal carcinomatosis (P <.001) and multifocal disease (P <.001) were associated with both decreased technical and clinical success. Procedure-related adverse events were seen in 12 patients (6.4%). In patients with clinical success, the incidence of stent occlusion at 3 months was 14.7% (95% confidence interval, 7.8%-21.6%) and was higher in patients with prior radiation therapy (P =.011). The median overall survival for all patients from time of attempted stent placement was 3.3 months (95% confidence interval, 3.0-4.1). Conclusions: This study represents the largest retrospective series of colonic stent placement for LBO in ECM patients in the literature. Our technical success rate of 75.9%, clinical success rate of 54.5%, and 3-month stent occlusion rate of 14.7% suggest that stent placement is a viable palliative option for patients with advanced disease because of ECM. Patients with peritoneal carcinomatosis and multifocal disease have reduced technical and clinical success. However, these factors should not dissuade an attempt at stent placement, if risk-to-benefit analysis is favorable. © 2018 American Society for Gastrointestinal Endoscopy
Journal Title: Gastrointestinal Endoscopy
Volume: 87
Issue: 5
ISSN: 0016-5107
Publisher: Mosby Elsevier  
Date Published: 2018-05-01
Start Page: 1310
End Page: 1317
Language: English
DOI: 10.1016/j.gie.2017.12.017
PROVIDER: scopus
PUBMED: 29307474
PMCID: PMC8439169
Notes: Article -- Export Date: 1 May 2018 -- Source: Scopus
Citation Impact
MSK Authors
  1. Junting Zheng
    183 Zheng
  2. Hans Gerdes
    164 Gerdes
  3. Arnold J Markowitz
    128 Markowitz
  4. Emmy Ludwig
    50 Ludwig
  5. Mark Schattner
    132 Schattner
  6. Pari Mayank Shah
    35 Shah
  7. Suhail B Salem
    3 Salem
  8. Shahdabul   Faraz
    4 Faraz