[Difficulty factors related to self-expandable metallic stent placement for malignant colonic obstruction]

Recently, the endoscopic placement of self-expandable metallic stents (SEMS) for malignant colorectal obstruction has been increasing, but the longer procedure time may cause serious complications. This study aimed to confirm the efficacy and factors that prolong the procedure time for SEMS placement. This study enrolled 92 patients who required SEMS placement for malignant colonic obstruction at the Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital from June 2015 to July 2024. The technical success rate was 95.7% and the clinical success rate was 92.4%. The total median procedure time was 37 min and the median procedure time for SEMS placement was 23 min. The major adverse events included perforation (3.3%), stent migration (4.3%), and stent occlusion (4.3%). Deaths related to SEMS placement were not reported. Multivariate analyses revealed significant associations between technically difficult placement and stricture length of ≥5cm (odds ratio [OR]:6.34;p=0.022) as well as lesions invisible from the front (OR:34.30;p<0.001). Endoscopic placement of SEMS for malignant colorectal obstruction is an effective treatment with a high success rate but requires careful attention for lesions that are invisible from the front.