Present Role of Gastrointestinal Stenting

A special issue of Medicina (ISSN 1648-9144).

Deadline for manuscript submissions: closed (1 March 2021) | Viewed by 9456

Special Issue Editors

Chief of the Surgical Oncology Unit, Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
Interests: general and colorectal surgery; laparoscopy; robotic surgery
Special Issues, Collections and Topics in MDPI journals
Department of Surgery Pietro Valdoni, Sapienza University of Rome, Rome, Italy
Interests: general; emergency; vascular surgery
Chief of the Endoscopy Unit, Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
Interests: endoscopy; advanced interventional endoscopy

Special Issue Information

Dear Colleagues, 

Gastrointestinal stent positioning offers an innovative and minimally invasive procedure in a select group of patients either in elective or emergent settings. These patients might be affected by benign or malignant diseases, and this device permits an efficacious alternative to open surgery.

This Special Issue aims to analyze the implications, limitations, and results of this innovative treatment.

Endoscopic stent positioning may have a key role in the current multimodality treatment of several gastrointestinal tumors. More than 30% of patients with adenocarcinoma of the pancreas or of the stomach present with an advanced unresectable disease, which determines a condition of gastric outlet obstruction. Endoscopic stenting avoids general anesthesia and a laparotomy, thus shortening hospital stay and improving patient discomfort. Furthermore, more than 25% of patients present with an initial diagnosis of stage IV colorectal cancer. Because the median survival period has extended to approximately 2 years with the use of novel cytotoxic and biologic agents, palliative treatment of the primary tumor with endoscopic stenting may improve quality of life and facilitate the return to an active life. Finally, endoscopic stent positioning also has an important role in the management of anastomotic colorectal fistulas or strictures and benign stenosis. 

A large community of physicians, including oncologists, radiation therapists, surgeons, and endoscopists, is involved and interested in this field. Stent positioning may represent an alternative to open surgery, having a definable effect on quality of life. 

We are available to provide any additional information you require. 

Prof. Enrico Fiori
Prof. Paolo Sapienza
Prof. Antonietta Lamazza
Guest Editors

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Keywords

  • Endoscopy
  • Stent positioning
  • Gastric cancer
  • Pancreatic cancer
  • Colon cancer
  • Rectal cancer
  • Rectovaginal fistulas
  • Benign colorectal stenosis
  • Anastomotic leakage
  • Anastomotic stricture

Published Papers (4 papers)

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Research

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9 pages, 1001 KiB  
Article
Palliative Surgery or Metallic Stent Positioning for Advanced Gastric Cancer: Differences in QOL
by Enrico Fiori, Daniele Crocetti, Paolo Sapienza, Roberto Cirocchi, Antonio V. Sterpetti, Michelangelo Miccini, Marcello Accordino, Silvano Costi, Pierfrancesco Lapolla, Andrea Mingoli, Giorgio De Toma and Antonietta Lamazza
Medicina 2021, 57(5), 428; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57050428 - 28 Apr 2021
Cited by 7 | Viewed by 1798
Abstract
Background and Objectives: Twenty percent of the patients affected with stage IV antropyloric stomach cancer are hospitalized with a gastric outlet obstruction syndrome (GOOS) requiring its resolution to improve the quality of life (QoL). We present our preliminary short- and mid-term results regarding [...] Read more.
Background and Objectives: Twenty percent of the patients affected with stage IV antropyloric stomach cancer are hospitalized with a gastric outlet obstruction syndrome (GOOS) requiring its resolution to improve the quality of life (QoL). We present our preliminary short- and mid-term results regarding the influence of endoscopic placement of self-expandable metal stent (SEMS) or open stomach-partitioning gastrojejunostomy in QoL. Materials and Methods: In this prospective randomized longitudinal cohort trial, we randomly assigned 27 patients affected with stage IV antropyloric stomach cancer into two groups: Group 1 (13 patients) who underwent SEMS positioning and Group 2 (14 patients) in whom open stomach-partitioning gastrojejunostomy was performed. The Karnofsky performance scale and QoL assessment using the EQ-5D-5L™ questionnaire was administered before treatment and thereafter at 1, 3, and 6 months. Results: At 1-month, index values showed a statistically significant deterioration of the QoL in patients of Group 2 when compared to those of Group 1 (p = 0.004; CI: 0.04 to 0.21). No differences among the groups were recorded at 3-month; whereas, at 6-month, the index values showed a statistically significant deterioration of the QoL in patients of Group 1 (p = 0.009; CI: −0.25 to −0.043). Conclusions: Early QoL of patients affected with stage IV antropyloric cancer and symptoms of GOOS is significantly better in patients treated with SEMS positioning but at 6-month the QoL significantly decrease in this group of patients. We explained the reasons of this fluctuation with the higher risk of re-hospital admission in the SEMS group. Full article
(This article belongs to the Special Issue Present Role of Gastrointestinal Stenting)
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8 pages, 804 KiB  
Article
Self-Expandable Metal Stents for Left Sided Colon Obstruction from Diverticulitis. A Single Center Retrospective Series
by Antonietta Lamazza, Maria Vittoria Carati, Anna Guzzo, Anna Maria Pronio, Virgilio Nicolanti, Angelo Antoniozzi, Antonio V. Sterpetti and Enrico Fiori
Medicina 2021, 57(3), 299; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030299 - 23 Mar 2021
Cited by 2 | Viewed by 1999
Abstract
Background and Objectives: The incidence of diverticulitis is increasing in western countries. Complicated diverticulitis is defined as diverticulitis associated with localized or generalized perforation, localized or distant abscess, fistula, stricture or obstruction. Colonic symptomatic strictures are often treated with segmental colectomy. The [...] Read more.
Background and Objectives: The incidence of diverticulitis is increasing in western countries. Complicated diverticulitis is defined as diverticulitis associated with localized or generalized perforation, localized or distant abscess, fistula, stricture or obstruction. Colonic symptomatic strictures are often treated with segmental colectomy. The aim of our study is to report our experience with Self Expandable Metal Stents (SEMS) placement to relieve sigmoid obstruction secondary to diverticulitis, either as a permanent solution or as a bridge to elective colectomy. Material and Methods: From January 2016 to December 2018, 21 patients underwent SEMS placement for sigmoid obstruction secondary to diverticulitis at our institution. In four patients with poor general conditions, SEMS was considered the definitive form of treatment. In 17 patients, the stent was placed as bridge to elective colectomy. Data were prospectively collected and retrospectively analyzed. Primary outcomes were postoperative mortality and morbidity after SEMS and subsequent elective colectomy. Results: There was no mortality or major morbidity after SEMS placement or subsequent elective colectomy. No stoma was performed. Conclusions: Placement of Colorectal Self Expandable Stent represents a useful tool to relieve obstruction in patients with left-sided colonic diverticulitis. SEMS placement makes it possible to transform an emergency clinical condition into an elective condition, giving time to resolve the inflammation and the infection inevitably associated with complicated diverticulitis. Full article
(This article belongs to the Special Issue Present Role of Gastrointestinal Stenting)
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Review

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9 pages, 302 KiB  
Review
Colonic Stenting in the Emergency Setting
by Mario Morino, Alberto Arezzo, Francesca Farnesi and Edoardo Forcignanò
Medicina 2021, 57(4), 328; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57040328 - 01 Apr 2021
Cited by 4 | Viewed by 2317
Abstract
Nowadays, colorectal cancer (CRC) is the third most frequent cancer, and about a third of patients with CRC presents themselves with symptoms of large bowel obstruction. Historically, surgical resection was the treatment of choice for colonic obstruction, but this kind of approach is [...] Read more.
Nowadays, colorectal cancer (CRC) is the third most frequent cancer, and about a third of patients with CRC presents themselves with symptoms of large bowel obstruction. Historically, surgical resection was the treatment of choice for colonic obstruction, but this kind of approach is burdened by a high risk of postoperative morbidity and mortality. In recent times, the use of a colonic stent has been proposed to overcome the obstruction and transform an emergency surgical case into an elective one to avoid emergency surgery complications. Endoscopic stenting is the first-line treatment option in the palliative management of colonic obstruction, and there is sufficient scientific evidence to support this approach. However, endoscopic stent used as a bridge to surgery is not yet widely adopted because the concern was raised about the long-term survival and cancer safety of this approach. The recent scientific evidence has shown that this approach improves the short-term outcomes, such as postoperative complications and the stoma rate, without differences in long-term outcomes compared to emergency surgery. Therefore, the European Society for Gastrointestinal Endoscopy in 2020 has reconsidered stenting as a bridge to surgery as a valid alternative to emergency surgery. Full article
(This article belongs to the Special Issue Present Role of Gastrointestinal Stenting)
13 pages, 2199 KiB  
Review
Current Status of the Self-Expandable Metal Stent as a Bridge to Surgery Versus Emergency Surgery in Colorectal Cancer: Results from an Updated Systematic Review and Meta-Analysis of the Literature
by Roberto Cirocchi, Alberto Arezzo, Paolo Sapienza, Daniele Crocetti, Davide Cavaliere, Leonardo Solaini, Giorgio Ercolani, Antonio V. Sterpetti, Andrea Mingoli and Enrico Fiori
Medicina 2021, 57(3), 268; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030268 - 15 Mar 2021
Cited by 12 | Viewed by 2777
Abstract
Background: The current use of endoscopic stenting as a bridge to surgery is not always accepted in standard clinical practice to treat neoplastic colonic obstructions. Objectives: The role of colonic self-expandable metal stent (SEMS) positioning as a bridge to resective surgery versus [...] Read more.
Background: The current use of endoscopic stenting as a bridge to surgery is not always accepted in standard clinical practice to treat neoplastic colonic obstructions. Objectives: The role of colonic self-expandable metal stent (SEMS) positioning as a bridge to resective surgery versus emergency surgery (ES) for malignant obstruction, using all new data and available variables, was studied and we focused on short- and long-term results. Materials and Methods: A systematic review with meta-analysis was performed. PubMed, SCOPUS and Web of Science databases were included. The search comprised only randomized controlled trials (RCTs) investigating the interventions that included SEMS positioning versus ES. The primary outcomes were the rates of overall postoperative mortality, clinical and technical success. The secondary outcomes were the short- and long-term results. Results: A total of 12 studies were eligible for further analyses. A laparoscopic colectomy was the most common operation performed in the SEMS group, whereas the traditional open approach was commonly used in the ES group. Intraoperative colonic lavage was seldomly performed during ES. There were no differences in mortality rates between the two groups (RR 1.06, 95% CI 0.55 to 2.04; I2 = 0%). In the SEMS group, the rate of successful primary anastomosis was significantly higher in of SEMS (69.75%) than in the ES (55.07%) (RR 1.26, 95% 245 CI 1.01 to 1.57; I2 = 86%). Conversely, the upfront Hartmann procedure was performed more frequently in the ES (39.1%) as compared to the SEMS group (23.4%) (RR 0.61, 95% CI 0.45 to 0.85; I2 = 23%). The overall postoperative complications rate was significantly lower in the SEMS group (32.74%) than in the ES group (48.25%) (RR 0.61, 95% CI 0.41 to 0.91; I2 = 65%). Conclusions: In the presence of malignant colorectal obstruction, SEMS is safe and associated with the same mortality and significantly lower morbidity than the ES group. The rate of successful primary anastomosis was significantly higher than the ES group. Nevertheless, recurrence and survival outcomes are not significantly different between the two groups. The analysis of short- and long-term results can suggest the use of SEMS as a bridge to resective surgery when it is performed by an endoscopist with adequate expertise in both colonoscopy and fluoroscopic techniques and who performed commonly colonic stenting. Full article
(This article belongs to the Special Issue Present Role of Gastrointestinal Stenting)
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