Premium
Severity of initial stent angulation predicts reintervention after successful palliative enteral stenting for malignant luminal obstruction
Author(s) -
Lee Eric Y T,
Bourke Michael J,
Williams Stephen J,
Alrubaie Ahmad,
Kwan Vu,
Bailey Adam A,
Lynch Paul M,
Loh Sze M
Publication year - 2011
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2010.06523.x
Subject(s) - medicine , stent , surgery , retrospective cohort study , hazard ratio , gastric outlet obstruction , confidence interval , enteral administration , parenteral nutrition
Background and Aim: Recurrent stent obstruction necessitating reintervention is problematic and incompletely understood. The aim of the present study was to identify factor(s) predisposing to reintervention. Methods: Retrospective review of patients ( n = 117) referred to a single major endoscopic referral centre for palliative enteral stenting from 1999 to 2006. Twelve were excluded due to inadequate follow‐up data ( n = 7) or initial radiographic documentation ( n = 5). A total of 105 patients (gastroduodenal n = 57, colonic n = 48) were therefore analyzed. The primary outcome of interest was recurrent obstruction necessitating reintervention. Kaplan–Meier analysis of potential factors predisposing to reintervention, including stent angulation (mild [<15°], moderate [15°–90°], severe [>90°]) was completed for 98 patients (technically successful enteral stenting). Results: Technical and clinical success were achieved in 98 of 105 (93.3%) and 92 of 98 (93.9%) cases, respectively. Post‐stenting median survival was 97.5 days (range 3–1054). Eighteen patients (18.4%) required reintervention for stent obstruction at a median time to reintervention of 85 days (range 7–481). Increased stent angulation (severe vs mild hazard ratio 6.73 (95% confidence interval 1.59–27.59), P = 0.009) was the only statistically significant factor in multivariate analysis predicting reintervention. Conclusions: Despite its limitation as a retrospective review, this study found that reintervention for stent obstruction is necessary in almost one in five cases, and increasing severity of stent angulation is the most important risk factor.