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Clinical outcomes and factors related to colonic perforations in patients receiving self-expandable metal stent insertion for malignant colorectal obstruction

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Author(s)
Yoo Jin LeeJin Young YoonJae Jun ParkSoo Jung ParkJie-Hyun KimYoung Hoon YounTae Il KimHyojin ParkWon Ho KimJae Hee Cheon
Keimyung Author(s)
Lee, Yoo Jin
Department
Dept. of Internal Medicine (내과학)
Journal Title
Gastrointestinal Endoscopy
Issued Date
2018
Volume
87
Issue
6
Abstract
BACKGROUND AND AIMS:

Although colonic perforation is a dreadful adverse event associated with stent placement, data on this topic are sparse. We aimed to investigate the clinical outcomes of colonic perforation and factors related to its occurrence in patients who received self-expandable metal stents (SEMSs) for malignant colorectal obstruction.

METHODS:

We retrospectively reviewed the data of 474 patients with malignant colorectal obstruction who received endoscopic SEMS insertion from April 2004 to May 2011 in Severance Hospital and Gangnam Severance Hospital. Early perforation, defined as perforation occurring within 2 weeks, was assessed in bridge-to-surgery (n = 164) and palliative stent placement patient groups (n = 310). Delayed perforation was analyzed using data from the palliative stent placement group alone.

RESULTS:

The technical and clinical success rates were 90.5% and 81.0%, respectively. Early and delayed perforations occurred in 2.7% (13/474) and 2.7% (8/301) of patients, respectively. Among 21 patients with perforation, 14 (66.7%) received emergency surgery and 5 (23.8%) died within 30 days after perforation. Regarding the perforation-related factors, age ≥70 years (odds ratio, 3.276; 95% confidence interval [CI], 1.041-10.309) and sigmoid colonic location (odds ratio, 7.706; 95% CI, 1.681-35.317) were independently associated with occurrence of early perforation. Stent location in the flexure (hazard ratio, 17.573; 95% CI, 2.004-154.093) and absence of peritoneal carcinomatosis (hazard ratio, 6.139; 95% CI, 1.150-32.776) were significantly associated with delayed perforation.

CONCLUSIONS:

The perforation-related 30-day mortality rate was 23.8%. Older age and sigmoid colonic location were significantly associated with occurrence of early perforation, whereas flexure location and absence of peritoneal carcinomatosis were related to delayed perforation.
Keimyung Author(s)(Kor)
이유진
Publisher
School of Medicine (의과대학)
Citation
Yoo Jin Lee et al. (2018). Clinical outcomes and factors related to colonic perforations in patients receiving self-expandable metal stent insertion for malignant colorectal obstruction. Gastrointestinal Endoscopy, 87(6), 1548–1548. doi: 10.1016/j.gie.2018.02.006
Type
Article
ISSN
0016-5107
Source
https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(18)30109-3
DOI
10.1016/j.gie.2018.02.006
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41124
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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