A Japanese Prospective, Multicenter Study of Colonic Stenting for Palliation Using a High Axial Force Self-Expandable Metal Stent for Malignant Large Bowel Obstruction in 200 Patients

Rei Ishibashi; Takashi Sasaki; Hiroyuki Isayama; Takeaki Matsuzawa; Toshio Kuwai; Tomonori Yamada; Shuji Saito; Masafumi Tomita; Toshiyasu Shiratori; Satoshi Ikeda; Hideki Kanazawa; Mitsuhiro Fujishiro; Iruru Maetani; Yoshihisa Saida

doi:10.3390/jcm12155134

A Japanese Prospective, Multicenter Study of Colonic Stenting for Palliation Using a High Axial Force Self-Expandable Metal Stent for Malignant Large Bowel Obstruction in 200 Patients

J Clin Med. 2023 Aug 5;12(15):5134. doi: 10.3390/jcm12155134.

Authors

Affiliations

¹ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan.
² Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
³ Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan.
⁴ Department of Surgery, Imusumiyoshi General Hospital, Saitama 354-0041, Japan.
⁵ Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima 737-0023, Japan.
⁶ Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi 466-8650, Japan.
⁷ Department of Surgery, Gastrointestinal Center, Yokohama Shin-Midori General Hospital, Kanagawa 226-0025, Japan.
⁸ Department of Surgery, Kobe Tokushukai Hospital, Hyogo 655-0017, Japan.
⁹ Department of Gastroenterology, Kameda Medical Center, Chiba 296-8602, Japan.
¹⁰ Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan.
¹¹ Department of Surgery, National Hospital Organization Sagamihara Hospital, Kanagawa 252-0392, Japan.
¹² Department of Gastroenterology, Sin-Kuki General Hospital, Saitama 346-8530, Japan.
¹³ Department of Surgery, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan.

Abstract

Evidence of the efficacy and safety of colorectal stent placement for palliation remains insufficient. This single-arm, prospective, multicenter study with a WallFlex enteral colonic stent included 200 consecutive patients with malignant large bowl obstruction in the palliation cohort. The technical and clinical success, as well as stent patency and complications as short-term (≤7 days) and long-term (>7 days) outcomes, of high axial force self-expandable metal stent (SEMS) placement was evaluated. The technical and clinical success rates were 98.5% and 94.5%, respectively. Non-recurrent colorectal obstruction at 1 year was 63.9%, and 71.2% of the patients remained free of recurrent colorectal obstruction until death or the last follow-up. Fifty-six patients (28.0%) received chemotherapy, and five patients were administered bevacizumab after stent placement. The overall complication rate was 47%, including four (2.0%) early-onset and ten (5.0%) late-onset perforations, mostly due to stent-edge injury. Only the use of a long SEMS was a risk factor for perforation. In conclusion, endoscopic colorectal stenting using high axial force SEMS is an effective and safe procedure for palliation in patients with malignant colorectal obstruction. However, care should be taken to avoid perforation at the stent edge when using a long SEMS.

Keywords: axial force; chemotherapy; malignant colorectal obstruction; palliation; self-expandable metal stent.

Grants and funding

This study was funded by the Japan Gastroenterological Endoscopy Society, Japanese Foundation for Research and Promotion of Endoscopy Grant, and Colonic Stent Safe Procedure Research Group membership dues.