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©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
Processing time: 106 Days and 4.3 Hours
ARTICLE HIGHLIGHTS
Research background
Colon obstruction due to benign and malignant etiologies at our tertiary care center is a fairly common problem however the wide spread use of colon stent is limited nationally with a nationwide analysis showing only 5.4% of patients with colon obstruction undergoing stent placement.
Research motivation
This under-utilization of colon stents for patient with colon obstruction prompted us to study the outcomes of patient undergoing colon stent placement for malignant and benign etiologies.
Research objectives
The objective of this study was to review long- and short-term clinical success of self-expandable metal stent (SEMS) use for colonic obstruction at a tertiary care center.
Research methods
We retrospectively reviewed all the patients who underwent colonic SEMS placement over an eighteen year period (August 2004 through August 2022) at our academic center.
Research 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 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).
Research conclusions
SEMS remain a worthwhile option for both palliative and preoperative indications in patients with malignant obstructions. Benign indications for SEMS placement appear to have similar success however there was a high rate of stent migration and perforation, our study was however limited by sample size to draw further concrete conclusions.
Research perspectives
Preoperative bridging needs further investigation into the long term risk of recurrence of disease. Further larger prospective multi center trails are needed to shed light on the use of colon stent placement especially for benign indications.
