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Ultraflex precision colonic stent placement for palliation of malignant colonic obstruction: a prospective
Alessandro Repici1, Diego Fregonese, Guido Costamagna
1Servizio di Endoscopia Digestiva, IRCCS Istituto Clinico Humanitas, Milano, Italy.
Background:
Many patients who develop obstructive colonic symptoms secondary to inoperable colorectal cancer will require palliative treatment. A minimally invasive and potentially long-lasting approach is placement of nitinol self-expanding metal stents (SEMS).
Objective:
To determine the effectiveness and safety of a nitinol SEMS designed for colorectal use in the palliative treatment of malignant colonic obstruction.
Design:
Prospective multicenter clinical study.
Setting:
Nine European study centers.
Patients:
Forty-four patients with malignant colonic obstruction.
Interventions:
Placement of nitinol SEMS designed for colorectal use.
Main Outcome Measures:
Technical success, defined as accurate SEMS deployment with adequate stricture coverage, and clinical success, defined as decompression and relief of obstructive colonic symptoms maintained without intervention or serious device-related complications.
Results:
Technical success was attained in 95% of patients, with 95% CI 85%-99%. After 6 months, the rate of clinical success was 81%, 95% CI 69%-96%. Survival at 6 months was 67%, 95% CI 54%-84%. Clinical success was maintained until death in 86% of the nonsurvivors. No perforations or SEMS-related deaths occurred.
Limitation:
This investigation was nonrandomized and did not include a control group.
Conclusions:
In a large prospective investigation, palliative placement of a nitinol SEMS designed for colorectal use was accomplished with a high rate of technical success. Durable clinical success was achieved in a high proportion of patients with low morbidity.
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