Clinical outcomes of secondary self-expandable metal stent (SEMS) insertion due to previous stent migration in malignant colorectal obstruction

Abstract

INTRODUCTION: Self-expanding metal stents (SEMS) are widely used for the relief of malignant colorectal obstruction. Recent clinical studies have found that SEMS placement is relatively safe and effective, but reported long-term complication rates ranging from 25-50%. There has been only limited research concerning the clinical outcomes of secondary SEMS placement after previous stent migration. The aim of this study was to assess clinical outcomes following secondary SEMS after stent migration compared to those of secondary stent insertion due to causes other than migration. METHODS: Self-expanding metal stents (SEMS) are widely used for the relief of malignant colorectal obstruction. Recent clinical studies have found that SEMS placement is relatively safe and effective, but reported long-term complication rates ranging from 25-50%. There has been only limited research concerning the clinical outcomes of secondary SEMS placement after previous stent migration. The aim of this study was to assess clinical outcomes following secondary SEMS after stent migration compared to those of secondary stent insertion due to causes other than migration. RESULTS: The baseline clinical characteristics were similar between the two groups. The overall immediate technical and clinical success rates of secondary SEMS insertion in the migration and non-migration groups were 94.7% and 83.3% (p-value 0.09) and 73.7% and 53.3% (p-value 0.122), respectively. In the migration group, immediate clinical success was associated with a history of immediate clinical success (first stent insertion) and a longer time interval between the first and second stent insertion. The overall clinical success was higher when there was no problem with maintenance of stent patency after the first stent insertion. Other factors including stent type, stent length, etiology of obstruction, or degree of obstruction did not differ significantly between groups. CONCLUSION: The success rate of secondary SEMS insertion following stent migration did not differ from that of secondary stent insertion due to other causes. The immediate and long-term clinical success rates following migration were dependent on the success of the first stent, suggesting that the success of the first procedure may be useful for selecting further treatment options, notably stent insertion versus surgical intervention.