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Endoscopic stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery.

Authors
 Bo Kyung Kim  ;  Sung Pil Hong  ;  Hyun Mi Heo  ;  Jin Young Kim  ;  Hyuk Hur  ;  Kang Young Lee  ;  Jae Hee Cheon  ;  Tae Il Kim  ;  Won Ho Kim 
Citation
 GASTROINTESTINAL ENDOSCOPY, Vol.75(2) : 294-301, 2012 
Journal Title
 GASTROINTESTINAL ENDOSCOPY 
ISSN
 0016-5107 
Issue Date
2012
MeSH
Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Colonic Neoplasms/complications ; Colonic Neoplasms/secondary* ; Emergencies ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Intestinal Obstruction/therapy* ; Intestinal Perforation/etiology ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Palliative Care/methods* ; Prosthesis Failure ; Recurrence ; Retrospective Studies ; Stents*/adverse effects ; Stomach Neoplasms/pathology* ; Treatment Outcome ; Young Adult
Keywords
Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Colonic Neoplasms/complications ; Colonic Neoplasms/secondary* ; Emergencies ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Intestinal Obstruction/therapy* ; Intestinal Perforation/etiology ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Palliative Care/methods* ; Prosthesis Failure ; Recurrence ; Retrospective Studies ; Stents*/adverse effects ; Stomach Neoplasms/pathology* ; Treatment Outcome ; Young Adult
Abstract
BACKGROUND: Although self-expandable metal stent (SEMS) insertion has been shown to be an effective therapy for palliation of obstruction from colorectal malignancy, the clinical efficacy of SEMS insertion in the palliation of colorectal obstruction from an extracolonic malignancy (ECM) has not been extensively evaluated. OBJECTIVE: The aim of this study was to evaluate the clinical outcomes and complications of SEMSs compared with those of emergency surgery for relief of colorectal obstruction in patients with advanced gastric cancer (AGC). DESIGN: Retrospective study. PATIENTS: From January 2000 to December 2009, patients with AGC who were treated with SEMSs (N = 111) or emergency surgery (N = 69) for palliation of malignant colorectal obstruction were included. INTERVENTION: SEMS insertion or surgery. RESULTS: Although acute complications and stoma formations were lower in the SEMS group than in the surgery group, the clinical efficacy of SEMSs was inferior to emergency surgery (technical success, 73.9% vs 94.2%, P = .001; clinical success, 54.1% vs 75.4%, P = .005). SEMS-related complications occurred in 64.5%, including reobstruction (36.8%), stent migration (10.5%), perforation (13.2%), and bleeding (3.9%). The median duration of patency was not statistically different between the patients who underwent SEMS insertion and those who underwent emergency surgery (117 days vs 183 days, P = .105). Patients with fewer than 2 obstructive sites or less than 2 years to obstructive symptom onset after diagnosis of AGC showed better clinical outcomes after endoscopic stenting. LIMITATIONS: Retrospective and single-center study. CONCLUSIONS: SEMS insertion seems to be less effective than emergency surgery for the palliation of colorectal obstruction in patients with AGC. Further study is necessary to define those patients with ECM who may benefit from SEMS insertion.
Full Text
http://www.sciencedirect.com/science/article/pii/S0016510711022140
DOI
22154416
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Bo Kyung(김보경)
Kim, Won Ho(김원호) ORCID logo https://orcid.org/0000-0002-5682-9972
Kim, Jin Young(김진영)
Kim, Tae Il(김태일) ORCID logo https://orcid.org/0000-0003-4807-890X
Lee, Kang Young(이강영)
Cheon, Jae Hee(천재희) ORCID logo https://orcid.org/0000-0002-2282-8904
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
Hong, Sung Pil(홍성필)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/90301
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