The learning curve for colorectal stent insertion for the treatment of malignant colorectal obstruction

Abstract

Background/Aims: Although self-expanding metal stent (SEMS) insertion is widely used for the relief of malignant colorectal obstruction, the optimal learning requirements for SEMS insertion remain unknown. We aimed to assess the effectiveness of SEMS insertion by evaluating the learning curve in relation to the experience of an endoscopist.Subjects & Methods: We retrospectively analyzed the outcomes of 120 SEMS insertion procedures performed by one endoscopist in patients with malignant colorectal obstruction. We compared the technical and clinical success rates, the complication rates, and the duration of the procedures by quartiles.Results: The mean age of the patients (76 men and 44 women) was 64.6 years. The overall technical success rate was 95.0% (114/120), and the clinical success rate was 90.0% (108/120). The median procedure duration was 16.2 minutes (range, 3.4-96.5 minutes). From the first to the last quartile, the technical success rates were 90.0%, 96.7%, 96.7%, and 96.7% (P = 0.263), and the clinical success rates were 90.0%, 90.0%, 96.7%, and 83.3% (p = 0.588), respectively. Procedure-related complications were observed in 28 patients (23.3%). The complication rates for SEMS insertion by quartiles were 26.7%, 23.3%, 10.0%, and 33.3% (P = 0.184), respectively. Moreover, the number of stents per procedure was 1.13, 1.03, 1.00, and 1.00 (P = 0.029), respectively. The median duration of SEMS insertion significantly decreased from 20.9 to 14.8 minutes after the first 30 procedures (P = 0.005). Conclusions: An experienced endoscopist was able to perform the SEMS insertion procedure easily and effectively after performing 30 SEMS insertions.