Radiation Exposure with Self-Expandable Metallic Stent versus Transanal Decompression Tube for Malignant Colorectal...

Area of Science:

• Gastroenterology
• Interventional Radiology
• Oncology

Background:

• Malignant colorectal obstruction (MCO) management often involves self-expandable metallic stent (SEMS) or transanal decompression tube (TDT) placement.
• Radiation exposure (RE) differences between SEMS and TDT for MCO are not well-established.

Purpose of the Study:

• To compare radiation exposure (RE) between SEMS and TDT placement for malignant colorectal obstruction (MCO).
• To evaluate the impact of obstruction location on RE for both procedures.

Main Methods:

• A multi-center, prospective observational study involving 236 patients undergoing SEMS or TDT placement.
• Propensity score matching (PSM) was used to create comparable groups.
• Radiation exposure was quantified using air kerma at the patient entrance reference point (K_a,r) and air kerma-area product (P_KA).

Main Results:

• After PSM, 61 patients were analyzed in each group.
• Overall, SEMS placement resulted in significantly higher median K_a,r compared to TDT (77.4 vs. 55.6 mGy; p = 0.025).
• For rectal obstruction, SEMS showed significantly higher K_a,r and P_KA than TDT (p < 0.006). No significant difference was observed for colonic obstruction.

Conclusions:

• Transanal decompression tube (TDT) placement may be preferable for malignant rectal obstruction due to lower radiation exposure and technical benefits.
• Self-expandable metallic stent (SEMS) placement remains the recommended initial decompression strategy for malignant colonic obstruction, aligning with current guidelines.