Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2023; 15(4): 309-318
Published online Apr 16, 2023. doi: 10.4253/wjge.v15.i4.309
Outcomes of colon self–expandable metal stents for malignant vs benign indications at a tertiary care center and review of literature
Saqib Walayat, Andrew J Johannes, Mark Benson, Eric Nelsen, Ahmed Akhter, Gregory Kennedy, Anurag Soni, Mark Reichelderfer, Patrick Pfau, Deepak Gopal
Saqib Walayat, Andrew J Johannes, Department of Gastroenterology, University of Wisconsin, Madison, WI 53705, United States
Mark Benson, Ahmed Akhter, Anurag Soni, Patrick Pfau, Department of Gastroenterology and Hepatology, University of Wisconsin, Madison, WI 53705, United States
Eric Nelsen, Gastroenterology, Park Nicollet Digestive and Endoscopy Center, Methodist Hospital, St. Louis Park, Minneapolis, MN 55426, United States
Gregory Kennedy, Department of Surgery, University of Alabama-Birmingham School of Medicine, Brimingham, AL 35243, United States
Mark Reichelderfer, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, United States
Deepak Gopal, Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin Hospitals and Clinics, Madison, WI 53705, United States
Author contributions: Walayat S and Johannes AJ did the literature review, wrote and finalized the manuscript; Nelsen E and Akhter A collected the data; Benson M, Kennedy G, Soni A, Reichelderfer M and Pfau P designed the research study; Gopal D designed the study and analyzed the data and reviewed the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the University of Wisconsin Institutional Review Board.
Informed consent statement: All authors have reviewed the study and are aware of the final material being submitted. The study was also approved by the IRB board at UW Madison.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at dvg@medicine.wisc.edu.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deepak Gopal, MD, FRCP(C), FACP, AGAF, FACG, FASGE, MRCP(London), Professor, Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin Hospitals and Clinics, 1685 Highland Avenue, Madison, WI 53705, United States. dvg@medicine.wisc.edu
Received: December 29, 2022
Peer-review started: December 29, 2022
First decision: January 20, 2023
Revised: February 9, 2023
Accepted: April 4, 2023
Article in press: April 4, 2023
Published online: April 16, 2023
Abstract
BACKGROUND

Endoscopic placement of a self-expandable metal stent (SEMS) is a minimally invasive treatment for use in malignant and benign colonic obstruction. However, their widespread use is still limited with a nationwide analysis showing only 5.4% of patients with colon obstruction undergoing stent placement. This underutilization could be due to perceived increase risk of complications with stent placement.

AIM

To review long- and short-term clinical success of SEMS use for colonic obstruction at our center.

METHODS

We retrospectively reviewed all the patients who underwent colonic SEMS placement over a eighteen year period (August 2004 through August 2022) at our academic center. Demographics including age, gender, indication (malignant and benign), technical success, clinical success, complications (perforation, stent migration), mortality, and outcomes were recorded.

RESULTS

Sixty three patients underwent colon SEMS over an 18-year period. Fifty-five cases were for malignant indications, 8 were for benign conditions. The benign strictures included diverticular disease stricturing (n = 4), fistula closure (n = 2), extrinsic fibroid compression (n = 1), and ischemic stricture (n = 1). Forty-three of the malignant cases were due to intrinsic obstruction from primary or recurrent colon cancer; 12 were from extrinsic compression. Fifty-four strictures occurred on the left side, 3 occurred on the right and the rest in transverse colon. The total malignant case (n = 55) procedural success rate was 95% vs 100% for benign cases (P = 1.0, NS). Overall complication rate was significantly higher for benign group: Four complications were observed in the malignant group (stent migration, restenosis) vs 2 of 8 (25%) for benign obstruction (1-perforation, 1-stent migration) (P = 0.02). When stratifying complications of perforation and stent migration there was no significant difference between the two groups (P = 0.14, NS).

CONCLUSION

Colon SEMS remains a worthwhile option for colonic obstruction related to malignancy and has a high procedural and clinical success rate. Benign indications for SEMS placement appear to have similar success to malignant. While there appears to be a higher overall complication rate in benign cases, our study is limited by sample size. When evaluating for perforation alone there does not appear to be any significant difference between the two groups. SEMS placement may be a practical option for indications other that malignant obstruction. Interventional endoscopists should be aware and discuss the risk for complications in setting of benign conditions. Indications in these cases should be discussed in a multi-disciplinary fashion with colorectal surgery.

Keywords: Colon cancer, Obstruction, malignancy, Stricture, Self-expandable metal stent, Stent migration

Core Tip: Endoscopic self-expandable metal stent placement remains an underutilized option for malignant and benign colonic obstruction. We retrospectively evaluated sixty three patients with colon malignant obstruction. Fifty five patients had malignant obstruction and 8 had benign colonic obstruction. Procedural success rate was 95% for benign and 100% for malignant obstruction. No difference in complications were noted between and malignant obstruction.