Retrospective Study
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World J Gastroenterol. Oct 14, 2014; 20(38): 13936-13941
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13936
Endoscopic stenting for recurrence-related colorectal anastomotic site obstruction: Preliminary experience
Jung Ho Kim, Jong Joon Lee, Jae Hee Cho, Kyoung Oh Kim, Jun-Won Chung, Yoon Jae Kim, Kwang An Kwon, Dong Kyun Park, Ju Hyun Kim
Jung Ho Kim, Jong Joon Lee, Jae Hee Cho, Kyoung Oh Kim, Yoon Jae Kim, Kwang An Kwon, Dong Kyun Park, Ju Hyun Kim, Jun Won Chung, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405-760, South Korea
Author contributions: Kim JH designed the research and wrote the paper; Lee JJ and Cho JH collected data; Kim KO, Chung JW and Kim YJ performed research; Kwon KA and Park DK analysed data; Kim JH coordinated and supervised this work.
Supported by Grants from Korea Health Technology R&D Project through the Korea Health Industry Development Institute, Funded by the Ministry of Health and Welfare, South Korea, No. HI13C-1602-010013; and Gachon University Gil Medical Center, No. 2013-37
Correspondence to: Ju Hyun Kim, MD, PhD, Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 405-760, South Korea. jhkim@gilhospital.com
Telephone: +82-32-4603778 Fax: +82-32-4603408
Received: April 7, 2014
Revised: June 10, 2014
Accepted: June 25, 2014
Published online: October 14, 2014
Abstract

AIM: To evaluate the efficacy of stents in treating patients with anastomotic site obstructions due to cancer recurrence following colorectal surgery.

METHODS: The medical records of patients who underwent endoscopic self-expanding metal stents (SEMS) insertion for colorectal obstructions between February 2004 and January 2014 were retrospectively reviewed. During the study period, a total of 218 patients underwent endoscopic stenting for colorectal obstructions. We identified and examined the patients who underwent endoscopic stenting for obstructions caused by cancer recurrence at the anastomotic site following colorectal surgeries for primary colorectal cancer.

RESULTS: Five consecutive patients [mean age, 56.4 years (range: 39-82 years); 4 women, 1 man] underwent endoscopic stenting for obstructions caused by cancer recurrence at the anastomotic site following colorectal surgeries for primary colorectal cancer. Technical and clinical success was achieved in all 5 patients, without any early complications. During follow-up, 3 patients did not need further intervention, prior to their death, after the first stent insertion; thus, the overall success rate was 3/5 (60%). Perforations occurred in 2 patients who required a second SEMS insertion due to re-obstruction; none of the patients experienced stent migration.

CONCLUSION: SEMS placement is a promising treatment option for patients who develop obstructions of their colonic anastomosis sites due to cancer recurrence.

Keywords: Colorectal neoplasms, Endoscopy, Intestinal obstruction, Stents, Surgical anastomosis

Core tip: No studies have investigated the clinical outcome of the use of self-expanding metal stents (SEMS) for the palliation of patients with obstructions of colorectal anastomosis sites due to cancer recurrence, following primary colorectal cancer surgery. The mechanism of obstruction differs between primary colorectal cancer and recurrence-related obstructions of the anastomotic site; the scar tissue at the anastomosis site may reduce the radial expansion force of SEMS in obstructions caused by intraluminal tumor growth. However, based on our experience, SEMS placement seems a promising treatment for patients who develop recurrence-related anastomotic site obstructions.