PMID- 28367495
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200930
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 5
IP  - 4
DP  - 2017 Apr
TI  - Long-term outcomes of palliative colonic stenting versus emergency surgery for 
      acute proximal malignant colonic obstruction: a multicenter trial.
PG  - E232-E238
LID - 10.1055/s-0043-102403 [doi]
AB  - Background and study aims Long-term data are limited regarding clinical outcomes 
      of self-expanding metal stents as an alternative for surgery in the treatment of 
      acute proximal MBO. The aim of this study was to compare the long-term outcomes 
      of stenting to surgery for palliation in patients with incurable obstructive CRC 
      for lesions proximal to the splenic flexure. Patients and methods Retrospective 
      multicenter cohort study of obstructing proximal CRC patients with who underwent 
      insertion of a SEMS (n = 69) or surgery (n = 36) from 1999 to 2014. The primary 
      endpoint was relief of obstruction. Secondary endpoints included technical 
      success, duration of hospital stay, early and late adverse events (AEs) and 
      survival. Results Technical success was achieved in 62/69 (89.8 %) patients in 
      the SEMS group and in 36 /36 (100 %) patients who underwent surgery (P = 0.09). 
      In the SEMS group, 10 patients underwent stenting as a bridge to surgery and 59 
      underwent stent placement for palliation. Clinical relief was achieved in 78 % of 
      patients with stenting and in 100 % of patients who underwent surgery 
      (P < 0.001). Patients with SEMS had significantly less acute AEs compared to the 
      surgery group (7.2 % vs. 30.5 %, P = 0.003). Hospital mortality for the SEMS 
      group was 0 % compared to 5.6 % in the surgery group (P = 0.11). Patients in the 
      SEMS group had a significantly shorter median hospital stay (4 days) as compared 
      to the surgery group (8 days) (P < 0.01). Maintenance of decompression without 
      the recurrence of bowel obstruction until death or last follow-up was lower in 
      the SEMS group (73.9 %) than the surgery group (97.3 %; P = 0.003). SEMS 
      placement was associated with higher long-term complication rates compared to 
      surgery (21 % and 11 % P = 0.27). Late SEMS AEs included occlusion (10 %), 
      migration (5 %), and colonic ulcer (6 %). At 120 weeks, survival in the SEMS 
      group was 5.6 % vs. 0 % in the surgery group (P = 0.8). Conclusions Technical and 
      clinical success associated with proximal colonic obstruction are higher with 
      surgery when compared to SEMS, but surgery is associated with longer hospital 
      stays and more early AEs. SEMS should be considered the initial mode of therapy 
      in patients with acute proximal MBO and surgery should be reserved for SEMS 
      failure, as surgery involves a high morbidity and mortality.
FAU - Siddiqui, Ali
AU  - Siddiqui A
AD  - Jefferson University School of Medicine, Gastroenterology and Hepatology, 
      Philadelphia, Pennsylvania, United States.
FAU - Cosgrove, Natalie
AU  - Cosgrove N
AD  - Jefferson University School of Medicine, Gastroenterology and Hepatology, 
      Philadelphia, Pennsylvania, United States.
FAU - Yan, Linda H
AU  - Yan LH
AD  - Jefferson University School of Medicine, Gastroenterology and Hepatology, 
      Philadelphia, Pennsylvania, United States.
FAU - Brandt, Daniel
AU  - Brandt D
AD  - Jefferson University School of Medicine, Gastroenterology and Hepatology, 
      Philadelphia, Pennsylvania, United States.
FAU - Janowski, Raymond
AU  - Janowski R
AD  - Jefferson University School of Medicine, Gastroenterology and Hepatology, 
      Philadelphia, Pennsylvania, United States.
FAU - Kalra, Ankush
AU  - Kalra A
AD  - Jefferson University School of Medicine, Gastroenterology and Hepatology, 
      Philadelphia, Pennsylvania, United States.
FAU - Zhan, Tingting
AU  - Zhan T
AD  - Jefferson University School of Medicine, Gastroenterology and Hepatology, 
      Philadelphia, Pennsylvania, United States.
FAU - Baron, Todd H
AU  - Baron TH
AD  - University of North Carolina, Gastroenterology and Hepatology, Chapel Hill, North 
      Carolina, United States.
FAU - Repici, Allesandro
AU  - Repici A
AD  - Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy.
FAU - Taylor, Linda Jo
AU  - Taylor LJ
AD  - University of Utah School of Medicine, Gastroenterology and Hepatology, Salt Lake 
      City, Utah, United States.
FAU - Adler, Douglas G
AU  - Adler DG
AD  - University of Utah School of Medicine, Gastroenterology and Hepatology, Salt Lake 
      City, Utah, United States.
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC5362371
COIS- Competing interests Drs. Siddiqui and Adler are consultants for Boston 
      Scientific.
EDAT- 2017/04/04 06:00
MHDA- 2017/04/04 06:01
PMCR- 2017/04/01
CRDT- 2017/04/04 06:00
PHST- 2017/04/04 06:00 [entrez]
PHST- 2017/04/04 06:00 [pubmed]
PHST- 2017/04/04 06:01 [medline]
PHST- 2017/04/01 00:00 [pmc-release]
AID - 10.1055/s-0043-102403 [doi]
PST - ppublish
SO  - Endosc Int Open. 2017 Apr;5(4):E232-E238. doi: 10.1055/s-0043-102403.