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WallFlex colonic stent placement for management of malignant colonic obstruction: a prospective study at two centers
Alessandro Repici1, Giuseppe De Caro, Carmelo Luigiano
1Milano, Bologna, Italy.
Background:
Self-expanding metal stents (SEMSs) can alleviate malignant colonic obstruction and avoid emergency decompressive surgery. The use of colonic larger-diameter SEMSs may improve bowel function and reduce migration risk.
Objective:
To evaluate the effectiveness and safety of a novel large-diameter SEMS (WallFlex) designed for delivery through the endoscope in treating malignant colonic obstruction.
Design:
Prospective clinical cohort study.
Setting:
Two Italian study centers.
Patients:
Forty-two consecutive patients with malignant colonic obstruction: 23 requiring palliation and 19 bridging to surgery.
Interventions:
Colorectal SEMS placement.
Main Outcome Measurements:
Technical success, defined as accurate SEMS deployment across the stricture on the first attempt; clinical success, ie, complete relief of bowel obstruction without complications; and bridging to surgery, denoting the performance of elective one-stage surgery.
Results:
The rate of technical success was 93% (95% CI, 81%-99%) and of initial clinical success was 95% (95% CI, 84%-99%). In 58% (95% CI, 40%-84%) of the palliation group, clinical success was maintained after 6 months. All 19 patients with operable tumors were successfully bridged to one-stage elective surgery within a median of 5 days. One perforation and one stent migration occurred. All complications could be resolved nonsurgically.
Limitations:
No control group was included.
Conclusions:
In a prospective study of through-the-scope WallFlex stent placement for malignant colonic obstruction, high rates of technical and initial clinical success, and bridging to surgery were achieved. Complications could be readily managed.
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