Endoscopy in Gastrointestinal Oncology - Slide 19 - A. Repici - Colorectal stents

Colonic Stenting Alessandro Repici, MD Digestive Endoscopy Unit Department of Gastroenterology IRCCS Istituto Clinico Humanitas, Milano, Italy

Large Bowel Malignant Obstruction ,[object Object],[object Object],[object Object],[object Object]

LBO: the management ,[object Object],[object Object],[object Object],[object Object]

S. Breitenstein, et al; Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction; British Journal of Surgery 2007; 94: 1451–1460 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Surgical management of malignant LBO

Colonic Stenting ,[object Object],[object Object],[object Object],[object Object],[object Object]

Technical issues ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The Technique ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],To me, emergency colorectal stenting may be one of the most challenging operative procedures in GI endoscopy The Technique

first 25-30 cm Rest of colon OTW STENT TTS STENT

Pooled analysis of clinical and technical success rates (54 trials – 1198 patients) Sebastian S et al. Am J Gastroenterol 2004 Group Number Cumulative Range Technical success Overall 1198 93% 64-100 Palliative 791 93% 67-100 Bridge to surgery 407 92% 33-100 Clinical success Overall 1198 89% 55-100 Palliative 791 91% 62-100 Bridge to surgery 407 72% 45-84

Repici A et al GIE 2008 Long-term palliation

SEMS-related complications ,[object Object],[object Object],[object Object]

There is concern about risk of perforation Van Hooft J et al Endoscopy 2008

Author Journal Pts Palliation/ BTS Type of stent Complications (%) Perforations (%) Law WL Colorectal Dis 2010 130 101/29 Esoph.Wallstent Colon Wallflex Choostent Enteral Wallstent Ultraflex 20 1,5 Baraza W. Colorectal Dis 2008 63 56/7 Niti-S Bard Memotherm 25 0 M. Alcantara Tech Coloproctol 2007 95 (103 SEMS) 28/67 Enteral Wallstent Esophacoil Hanaro stent Wallflex 13.7 4.2 Giovannini MD J clin Gastroenterol 2008 36 (52 SEMS) 36/0 Choostent Wallstent Hanaro stent 35 7.5 Brehant O Colorectal Dis 2009 30 0/30 Wallflex 23 7 Min Kyu Jung Surg Endosc 2009 39 39/0 Niti-S Hanarostent Wallflex Early 12.8 Late 11.8 Early 2.6 Late 2.9 S. Mucci-Hennekinne Surg Endosc 2007 67 55/12 Hanarostent ? 6,2 Repici A Gastroint Endosc 2008 42 23/19 Wallflex Early 9.5 Late 14.3 2.4 Jong Pil Im Int J Colorectal Dis 2008 49 pts (51SEMS) 49/0 Hanaro MI Tech 24 2

Small AJ et al. GIE 2010 Bevacizumab-based therapies and Colonic perforation after SEMS placement Is it time for a warning? Bevacizumab-based therapies Treated Untreated P 15.4% 6.8% 0.06

Cennamo V et al Clin Gastroenterol Hepatol 2009

49 y old lady: Feb-July 2009 FOLFOX4 Sept 2009-Jan 2010 FOLFIRI+Bevacizumab Feb 02 2010 Feb 04 2010 March 11 2010

Hapani S, et al Lancet Oncology 2009

Proper selection of patients for palliation with metal stents is a key-factor ,[object Object],[object Object],[object Object],[object Object]

Conclusions: Colonic Stenting ,[object Object],[object Object],[object Object],[object Object]

Endoscopy in Gastrointestinal Oncology - Slide 19 - A. Repici - Colorectal stents

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