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Jeanin E. van Hooft, MD, PhD Gastroenterologist Academic Medical Centre

Annual meeting of Colonic Stent Safe Procedure Research Group May 2014 17th, Fukuoka, Japan. Colonic stenting anno 2014. Jeanin E. van Hooft, MD, PhD Gastroenterologist Academic Medical Centre Dept. of Gastroenterology and Hepatology Amsterdam, Netherlands. Colonic stenting anno 2014.

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Jeanin E. van Hooft, MD, PhD Gastroenterologist Academic Medical Centre

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  1. Annual meeting of Colonic Stent Safe Procedure Research Group May 2014 17th, Fukuoka, Japan Colonic stenting anno 2014 Jeanin E. van Hooft, MD, PhD Gastroenterologist Academic Medical Centre Dept. of Gastroenterology and Hepatology Amsterdam, Netherlands

  2. Colonic stenting anno 2014 • Introduction • General considerations • Technical considerations • Indications • Palliation • Bridge to surgery • Oncological impact • Adverse events • Take home

  3. Colonic stenting anno 2014 General considerations • Contraindication for colonic stenting: • Absolute: • Suspicion of perforation • Relative • Lack of obstructive symptoms • Peritoneal carcinomatosis • Tumors close to the anal verge (< 5 cm) ESGE clinical guideline on SEMS for obstructing colonic cancer, Van Hooft et al., Endoscopy submitted

  4. Colonic stenting anno 2014 Technical considerations • Type of stent • Covered vs uncovered • Clinical and overall complications equal • Ingrowth 0.9% vs 11.4% and migration 21.3% vs 5.5% • Diameter • < 24 mm associated with the occurrence of complications Zhang et al., Colorectal Dis 2012 Yang et al., Int J Med Sci 2013 Kim et al., J Dig Dis 2012 Manes et al., Arch Surg 2011 Small et al., Gastrointest Endosc 2010 Im et al., Colorectal Dis 2008

  5. Colonic stenting anno 2014 Technical considerations • Type of stent • Length • No difference in outcome • Design • No difference in outcome Yoon et al., Gastrointest Endosc 2011 Selinger et al., Int J Colorectal dis 2011 Abbott et al., Br J Surg 2014 Geraghty et al., Colorectal dis 2014

  6. Colonic stenting anno 2014 New data on palliation

  7. Colonic stenting anno 2014 New data on palliation • Summary “There is no proven advantage with regard to overall mortality and morbidity and data on effectiveness are contradictious, but SEMS do have some specific advantages (shorter hospital stay, less stoma creation etc.) for palliation of incurable CRC”

  8. Colonic stenting anno 2014 New data on bridge

  9. Colonic stenting anno 2014 New data on bridge • Summary “Colorectal stenting is as safe as emergency surgery with regard to mortality and appears to have a more favorable overall complication profile and decreases the permanent stoma rate ”

  10. Colonic stenting anno 2014 Oncological impact

  11. Colonic stenting anno 2014 Oncological impact • Summary In the palliative setting chemotherapeutics do increase survival but at the expenses of reintervention In the curative setting SEMS might impair survival and increase (local) recurrence

  12. Colonic stenting anno 2014 Adverse events • SEMS for malignant colonic obstruction • Early adverse events (≤ 30 days) • Perforation 0-12.8% • Stent failure 0-11.7% • Pain 0-7.4% • Stent migration 0-4.9% • Reobstruction 0-4.9% • Bleeding 0-3.7% ESGE clinical guideline on SEMS for obstructing colonic cancer, Van Hooft et al., Endoscopy submitted

  13. Colonic stenting anno 2014 Adverse events • SEMS for malignant colonic obstruction • Late adverse events (≥ 30 days) • Reobstruction 4-22.9% • Migration 1-12.5% • Perforation 0-4% ESGE clinical guideline on SEMS for obstructing colonic cancer, Van Hooft et al., Endoscopy submitted

  14. Colonic stenting anno 2014 Adverse events • Effect of sum of complications • 30-day mortality <4% • Stent patency • Palliation Median 160 d (68-288 d) 80% (53-90%) until death • Bridge Large majority ESGE clinical guideline on SEMS for obstructing colonic cancer, Van Hooft et al., Endoscopy submitted

  15. Colonic stenting anno 2014 • Introduction • General considerations • Technical considerations • Indications • Palliation • Bridge to surgery • Oncological impact • Adverse events • Take home

  16. Colonic stenting anno 2014 Summary • General considerations • Contraindication for colonic stenting • Primary diagnostic tool • Pathological conformation • Preparation of obstructed patients • The operator • Technical considerations • Stent placement technique • Type of stent

  17. Colonic stenting anno 2014 Summary • Palliation • No proven advantage regarding overall mortality and morbidity • Data on effectiveness contradictious • Clear advantage regarding • Hospital stay, stoma formation, time to chemotherapy • Oncological impact (chemotherapy) • Better survival • More reinterventions

  18. Colonic stenting anno 2014 Summary • Bridge • No proven advantage regarding overall mortality • More favorable overall complication profiles • Decrease permanent stoma rate • Oncological impact • Might impair survival • Increase (local) recurrence

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