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Clinical outcomes and factors related to colonic perforations in patients receiving self-expandable metal stent insertion for malignant colorectal obstruction.

Authors
 Yoo Jin Lee  ;  Jin Young Yoon  ;  Jae Jun Park  ;  Soo Jung Park  ;  Jie-Hyun Kim  ;  Young Hoon Youn  ;  Tae Il Kim  ;  Hyojin Park  ;  Won Ho Kim  ;  Jae Hee Cheon 
Citation
 GASTROINTESTINAL ENDOSCOPY, Vol.87(6) : 1548-1557, 2018 
Journal Title
 GASTROINTESTINAL ENDOSCOPY 
ISSN
 0016-5107 
Issue Date
2018
MeSH
Aged ; Bile Duct Neoplasms/pathology ; Carcinoma/complications* ; Carcinoma/secondary ; Colonic Diseases/epidemiology* ; Colonic Diseases/surgery* ; Colonoscopy ; Colorectal Neoplasms/complications* ; Colorectal Neoplasms/secondary ; Emergencies/epidemiology ; Female ; Genital Neoplasms, Female/pathology ; Humans ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery* ; Intestinal Perforation/epidemiology* ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Pancreatic Neoplasms/pathology ; Peritoneal Neoplasms/epidemiology* ; Peritoneal Neoplasms/secondary ; Postoperative Complications/epidemiology* ; Proportional Hazards Models ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Self Expandable Metallic Stents* ; Stomach Neoplasms/pathology
Abstract
BACKGROUND AND AIMS: Although colonic perforation is a dreadful adverse event associated with stent placement, data on this topic are sparse. We aimed to investigate the clinical outcomes of colonic perforation and factors related to its occurrence in patients who received self-expandable metal stents (SEMSs) for malignant colorectal obstruction. METHODS: We retrospectively reviewed the data of 474 patients with malignant colorectal obstruction who received endoscopic SEMS insertion from April 2004 to May 2011 in Severance Hospital and Gangnam Severance Hospital. Early perforation, defined as perforation occurring within 2 weeks, was assessed in bridge-to-surgery (n = 164) and palliative stent placement patient groups (n = 310). Delayed perforation was analyzed using data from the palliative stent placement group alone. RESULTS: The technical and clinical success rates were 90.5% and 81.0%, respectively. Early and delayed perforations occurred in 2.7% (13/474) and 2.7% (8/301) of patients, respectively. Among 21 patients with perforation, 14 (66.7%) received emergency surgery and 5 (23.8%) died within 30 days after perforation. Regarding the perforation-related factors, age ≥70 years (odds ratio, 3.276; 95% confidence interval [CI], 1.041-10.309) and sigmoid colonic location (odds ratio, 7.706; 95% CI, 1.681-35.317) were independently associated with occurrence of early perforation. Stent location in the flexure (hazard ratio, 17.573; 95% CI, 2.004-154.093) and absence of peritoneal carcinomatosis (hazard ratio, 6.139; 95% CI, 1.150-32.776) were significantly associated with delayed perforation. CONCLUSIONS: The perforation-related 30-day mortality rate was 23.8%. Older age and sigmoid colonic location were significantly associated with occurrence of early perforation, whereas flexure location and absence of peritoneal carcinomatosis were related to delayed perforation.
Full Text
https://www.sciencedirect.com/science/article/pii/S0016510718301093
DOI
10.1016/j.gie.2018.02.006
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Won Ho(김원호) ORCID logo https://orcid.org/0000-0002-5682-9972
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
Kim, Tae Il(김태일) ORCID logo https://orcid.org/0000-0003-4807-890X
Park, Soo Jung(박수정)
Park, Jae Jun(박재준)
Park, Hyo Jin(박효진) ORCID logo https://orcid.org/0000-0003-4814-8330
Youn, Young Hoon(윤영훈) ORCID logo https://orcid.org/0000-0002-0071-229X
Cheon, Jae Hee(천재희) ORCID logo https://orcid.org/0000-0002-2282-8904
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/167503
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