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Comparison of different types of covered self-expandable metal stents for malignant colorectal obstruction

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Abstract

Background

Stent migration is one of the main drawbacks of covered self-expandable metal stent (SEMSs), occurring in up to 40% of malignant colorectal obstruction management cases. Various types of covered SEMSs have been developed to reduce this risk. We aimed to compare the effectiveness and complication rates of the flare-type covered SEMS (Flare) with those of the double-layered covered SEMS (ComVi).

Methods

We performed a prospective, randomized study in four tertiary referral centers between July 2016 and April 2018. Patients with malignant colorectal obstruction were eligible for the study. The primary outcome was migration rate as observed within the first month. Rates of technical success, clinical success, and complications within the first month were also assessed.

Results

A total of 60 patients were included (mean age, 70.5 ± 12.5 years; male, 31 [51.7%]). Flare and ComVi stents were applied in 30 patients each. The Flare and ComVi groups showed comparable technical success rates (90% [27/30] vs. 96.7% [29/30], p = 0.605) and clinical success rates (85.2% [23/27] vs. 75.9% [22/29], p = 0.589). Migration occurred in three (11.1%) and four (13.8%) cases in the Flare and ComVi groups, respectively, without significant difference (p = 0.99), and the risk of other complications, including perforation and re-obstruction, did not differ between the two groups.

Conclusions

Our study indicates that both flare-shape and double-layered covered SEMSs are equally effective options for the management of malignant colorectal obstruction with low migration rates when compared with previously reported migration risk of covered SEMS.

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Acknowledgements

Joon Seop Lee, Hyun Seok Lee, Eun Soo Kim, Min Kyu Jung, Jin Tae Jung, Ho Gak Kim, Dong Wook Lee, Dae Jin Kim, Yoo Jin Lee, and Chang Heon Yang: All authors are the member of Daegu-Gyeongbuk Gastrointestinal Study Group (DGSG).

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  1. Joon Seop Lee and Hyun Seok Lee contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea

    Joon Seop Lee, Hyun Seok Lee, Eun Soo Kim & Min Kyu Jung

  2. Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea

    Jin Tae Jung, Ho Gak Kim & Dong Wook Lee

  3. Department of Internal Medicine, Fatima Hospital of Daegu, Daegu, South Korea

    Dae Jin Kim

  4. Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea

    Yoo Jin Lee

  5. Department of Internal Medicine, Dongguk University School of Medicine, Gyeongju, South Korea

    Chang Heon Yang

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Contributions

Guarantor of the article: ESK. ESK contributed to study design, data analysis, statistical analysis, data interpretation, and critical revision; JSL and HSL equally contributed to study design, subject enrolment, data interpretation, and manuscript drafting as first authors; MKJ, JTJ, HGK, DWL, DJK, YJL, and CHY enrolled subjects and edited the manuscript. All authors approved the final version of the manuscript.

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Correspondence to Eun Soo Kim.

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Joon Seop Lee, Hyun Seok Lee, Eun Soo Kim, Min Kyu Jung, Jin Tae Jung, Ho Gak Kim, Dong Wook Lee, Dae Jin Kim, Yoo Jin Lee, and Chang Heon Yang have no conflicts of interest or financial ties to disclose.

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Lee, J.S., Lee, H.S., Kim, E.S. et al. Comparison of different types of covered self-expandable metal stents for malignant colorectal obstruction. Surg Endosc 35, 4124–4133 (2021). https://doi.org/10.1007/s00464-020-07869-x

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