The Experts below are selected from a list of 4689 Experts worldwide ranked by ideXlab platform
Sung Pil Hong - One of the best experts on this subject based on the ideXlab platform.
-
what is the necessity of endoscopist for successful Endoscopic Stenting in patients with malignant colorectal obstruction
International Journal of Colorectal Disease, 2015Co-Authors: Hyun Jung Lee, Soo Jung Park, Jae Hee Cheon, Tae Il Kim, Won Ho Kim, Sung Pil HongAbstract:Recently, self-expandable metal stents (SEMSs) have been widely used as an initial therapy for relieving malignant colorectal obstructions. However, several factors, including the endoscopist’s experience, affect the clinical outcome of SEMSs. The aim of this study was to define the adequate level of experience necessary to perform Endoscopic Stenting effectively and safely and to identify technical factors for successful Stenting. Between March 2009 and June 2012, 160 patients underwent SEMS placement for malignant colorectal obstruction with the intent of palliation or as a bridge to surgery by a single endoscopist who experienced colonoscopy and Endoscopic retrograde cholangiopancreatography. The overall technical and clinical success rates were 86.9 and 86.4 %, respectively, and 18 complications (11.3 %) were observed. There were no differences in any of the clinical outcomes between the consecutive blocks; however, the procedure time decreased significantly after the first 30 procedures (17.4, 16.9, 13.5, and 12.8 min; P = 0.044). American Society of Anesthesiologists (ASA) class, history of a previous operation, proximal colon obstruction, obstruction caused by an extracolonic malignancy, and palliative SEMS placement were associated with technical failure. An endoscopist who experiences a colonoscopy and fluoroscopy performs SEMS placement successfully regardless of the level of experience. After the first 30 procedures, a SEMS insertion could be safely and effectively performed with short procedure time in patients with malignant colorectal obstruction.
-
What is the necessity of endoscopist for successful Endoscopic Stenting in patients with malignant colorectal obstruction?
International Journal of Colorectal Disease, 2015Co-Authors: Soo Jung Park, Jae Hee Cheon, Sung Pil HongAbstract:Background and aim Recently, self-expandable metal stents (SEMSs) have been widely used as an initial therapy for relieving malignant colorectal obstructions. However, several factors, including the endoscopist’s experience, affect the clinical outcome of SEMSs. The aim of this study was to define the adequate level of experience necessary to perform Endoscopic Stenting effectively and safely and to identify technical factors for successful Stenting. Methods Between March 2009 and June 2012, 160 patients underwent SEMS placement for malignant colorectal obstruction with the intent of palliation or as a bridge to surgery by a single endoscopist who experienced colonoscopy and Endoscopic retrograde cholangiopancreatography. Results The overall technical and clinical success rates were 86.9 and 86.4 %, respectively, and 18 complications (11.3 %) were observed. There were no differences in any of the clinical outcomes between the consecutive blocks; however, the procedure time decreased significantly after the first 30 procedures (17.4, 16.9, 13.5, and 12.8 min; P = 0.044). American Society of Anesthesiologists (ASA) class, history of a previous operation, proximal colon obstruction, obstruction caused by an extracolonic malignancy, and palliative SEMS placement were associated with technical failure. Conclusions An endoscopist who experiences a colonoscopy and fluoroscopy performs SEMS placement successfully regardless of the level of experience. After the first 30 procedures, a SEMS insertion could be safely and effectively performed with short procedure time in patients with malignant colorectal obstruction.
-
The role of primary colectomy after successful Endoscopic Stenting in patients with obstructive metastatic colorectal cancer.
Diseases of the Colon & Rectum, 2014Co-Authors: Hyun Jung Lee, Soo Jung Park, Byung So Min, Jae Hee Cheon, Tae Il Kim, Nam Kyu Kim, Won Ho Kim, Sung Pil HongAbstract:BACKGROUND Although the initial clinical efficacy of self-expandable metal stents is acceptable, doubt still remains about long-term clinical outcomes and complications. OBJECTIVE The aim of this study was to evaluate the stoma formation rate and risk factors for complications after successful Stenting in patients with obstructive metastatic colorectal cancer. DESIGN This was a tertiary-care center retrospective study. PATIENTS From January 2000 to December 2010, 130 patients with unresectable obstructive colorectal cancer received successful self-expandable metal stent placement. Among them, 14 patients received primary colectomy after successful Stenting. INTERVENTIONS Self-expandable metal stent placement and primary colectomy were performed. MAIN OUTCOME MEASURES The stoma formation rate and complications were measured. RESULTS In patients with successful Stenting, stoma formation rates at 1 and 2 years were 15.6% (95% CI, 8.74-22.4) and 24.4% (95% CI, 13.8-35.0), and the median patency duration was 157 days (range, 2-1590 days). However, long-term complications occurred in 58 patients (44.6%), including reobstruction (32.6%), stent migration (10.3%), and perforation (7.8%), and a large number of reinterventions (45.7%) and hospitalizations (37/9%) were needed to manage complications. In multivariate analysis, primary colectomy after successful Endoscopic Stenting was a negative predictive factor for reobstruction (OR, 0.12; 95% CI, 0.02-0.99; p = 0.04). LIMITATIONS This was a retrospective, single-center study. CONCLUSIONS To reduce stent-related late complications, primary colectomy after successful Endoscopic Stenting could be a therapeutic option in patients who have unresectable colorectal cancer with obstruction, especially in those who expect long-term survival.
-
Endoscopic Stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery
Gastrointestinal Endoscopy, 2012Co-Authors: Bo Kyung Kim, Jae Hee Cheon, Tae Il Kim, Sung Pil Hong, Hyun Heo, Jin Young Kim, Hyuk Hur, Kang Young Lee, Won Ho KimAbstract:Background Although self-expandable metal stent (SEMS) insertion has been shown to be an effective therapy for palliation of obstruction from colorectal malignancy, the clinical efficacy of SEMS insertion in the palliation of colorectal obstruction from an extracolonic malignancy (ECM) has not been extensively evaluated. Objective The aim of this study was to evaluate the clinical outcomes and complications of SEMSs compared with those of emergency surgery for relief of colorectal obstruction in patients with advanced gastric cancer (AGC). Design Retrospective study. Patients From January 2000 to December 2009, patients with AGC who were treated with SEMSs (N = 111) or emergency surgery (N = 69) for palliation of malignant colorectal obstruction were included. Intervention SEMS insertion or surgery. Results Although acute complications and stoma formations were lower in the SEMS group than in the surgery group, the clinical efficacy of SEMSs was inferior to emergency surgery (technical success, 73.9% vs 94.2%, P = .001; clinical success, 54.1% vs 75.4%, P = .005). SEMS-related complications occurred in 64.5%, including reobstruction (36.8%), stent migration (10.5%), perforation (13.2%), and bleeding (3.9%). The median duration of patency was not statistically different between the patients who underwent SEMS insertion and those who underwent emergency surgery (117 days vs 183 days, P = .105). Patients with fewer than 2 obstructive sites or less than 2 years to obstructive symptom onset after diagnosis of AGC showed better clinical outcomes after Endoscopic Stenting. Limitations Retrospective and single-center study. Conclusions SEMS insertion seems to be less effective than emergency surgery for the palliation of colorectal obstruction in patients with AGC. Further study is necessary to define those patients with ECM who may benefit from SEMS insertion.
-
long term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers Endoscopic Stenting versus surgery
Gastrointestinal Endoscopy, 2010Co-Authors: Hyun Jung Lee, Byung So Min, Jae Hee Cheon, Tae Il Kim, Nam Kyu Kim, Sung Pil Hong, Won Ho KimAbstract:Background Self-expandable metal stents (SEMSs) provide a promising alternative for initial palliation of malignant bowel obstruction. However, data on the long-term outcomes of SEMSs are limited. Objective The aim of this study was to compare the long-term outcomes of Endoscopic Stenting with those of surgery for palliation in patients with incurable obstructive colorectal cancer. Designs and Setting A retrospective study. Patients From January 2000 to December 2008, patients with incurable obstructive colorectal cancer who were treated with SEMSs (n = 71) or palliative surgery (n = 73) were reviewed. Interventions SEMS placement by using through-the-endoscope methods or surgery. Main Outcome Measurements Success rates and complication rates. Results Early success rates in the SEMS group and those in the surgery group were not different (95.8% vs 100%, P = .12), and the SEMS group had fewer early complications than the surgery group (15.5% vs 32.9%, P = .015). Although the patency duration of the first stent in the SEMS group was shorter than that in the surgery group ( P P = .239). There were more late complications in the SEMS group than in the surgery group ( P = .028), but the rates of major complications did not differ between the 2 groups ( P = .074). Limitations Retrospective and single-center study. Conclusions SEMSs were not only an effective and acceptable therapy for initial palliation of malignant colorectal obstruction, but they also showed long-term efficacy comparable to that with surgery.
Won Ho Kim - One of the best experts on this subject based on the ideXlab platform.
-
what is the necessity of endoscopist for successful Endoscopic Stenting in patients with malignant colorectal obstruction
International Journal of Colorectal Disease, 2015Co-Authors: Hyun Jung Lee, Soo Jung Park, Jae Hee Cheon, Tae Il Kim, Won Ho Kim, Sung Pil HongAbstract:Recently, self-expandable metal stents (SEMSs) have been widely used as an initial therapy for relieving malignant colorectal obstructions. However, several factors, including the endoscopist’s experience, affect the clinical outcome of SEMSs. The aim of this study was to define the adequate level of experience necessary to perform Endoscopic Stenting effectively and safely and to identify technical factors for successful Stenting. Between March 2009 and June 2012, 160 patients underwent SEMS placement for malignant colorectal obstruction with the intent of palliation or as a bridge to surgery by a single endoscopist who experienced colonoscopy and Endoscopic retrograde cholangiopancreatography. The overall technical and clinical success rates were 86.9 and 86.4 %, respectively, and 18 complications (11.3 %) were observed. There were no differences in any of the clinical outcomes between the consecutive blocks; however, the procedure time decreased significantly after the first 30 procedures (17.4, 16.9, 13.5, and 12.8 min; P = 0.044). American Society of Anesthesiologists (ASA) class, history of a previous operation, proximal colon obstruction, obstruction caused by an extracolonic malignancy, and palliative SEMS placement were associated with technical failure. An endoscopist who experiences a colonoscopy and fluoroscopy performs SEMS placement successfully regardless of the level of experience. After the first 30 procedures, a SEMS insertion could be safely and effectively performed with short procedure time in patients with malignant colorectal obstruction.
-
The role of primary colectomy after successful Endoscopic Stenting in patients with obstructive metastatic colorectal cancer.
Diseases of the Colon & Rectum, 2014Co-Authors: Hyun Jung Lee, Soo Jung Park, Byung So Min, Jae Hee Cheon, Tae Il Kim, Nam Kyu Kim, Won Ho Kim, Sung Pil HongAbstract:BACKGROUND Although the initial clinical efficacy of self-expandable metal stents is acceptable, doubt still remains about long-term clinical outcomes and complications. OBJECTIVE The aim of this study was to evaluate the stoma formation rate and risk factors for complications after successful Stenting in patients with obstructive metastatic colorectal cancer. DESIGN This was a tertiary-care center retrospective study. PATIENTS From January 2000 to December 2010, 130 patients with unresectable obstructive colorectal cancer received successful self-expandable metal stent placement. Among them, 14 patients received primary colectomy after successful Stenting. INTERVENTIONS Self-expandable metal stent placement and primary colectomy were performed. MAIN OUTCOME MEASURES The stoma formation rate and complications were measured. RESULTS In patients with successful Stenting, stoma formation rates at 1 and 2 years were 15.6% (95% CI, 8.74-22.4) and 24.4% (95% CI, 13.8-35.0), and the median patency duration was 157 days (range, 2-1590 days). However, long-term complications occurred in 58 patients (44.6%), including reobstruction (32.6%), stent migration (10.3%), and perforation (7.8%), and a large number of reinterventions (45.7%) and hospitalizations (37/9%) were needed to manage complications. In multivariate analysis, primary colectomy after successful Endoscopic Stenting was a negative predictive factor for reobstruction (OR, 0.12; 95% CI, 0.02-0.99; p = 0.04). LIMITATIONS This was a retrospective, single-center study. CONCLUSIONS To reduce stent-related late complications, primary colectomy after successful Endoscopic Stenting could be a therapeutic option in patients who have unresectable colorectal cancer with obstruction, especially in those who expect long-term survival.
-
Endoscopic Stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery
Gastrointestinal Endoscopy, 2012Co-Authors: Bo Kyung Kim, Jae Hee Cheon, Tae Il Kim, Sung Pil Hong, Hyun Heo, Jin Young Kim, Hyuk Hur, Kang Young Lee, Won Ho KimAbstract:Background Although self-expandable metal stent (SEMS) insertion has been shown to be an effective therapy for palliation of obstruction from colorectal malignancy, the clinical efficacy of SEMS insertion in the palliation of colorectal obstruction from an extracolonic malignancy (ECM) has not been extensively evaluated. Objective The aim of this study was to evaluate the clinical outcomes and complications of SEMSs compared with those of emergency surgery for relief of colorectal obstruction in patients with advanced gastric cancer (AGC). Design Retrospective study. Patients From January 2000 to December 2009, patients with AGC who were treated with SEMSs (N = 111) or emergency surgery (N = 69) for palliation of malignant colorectal obstruction were included. Intervention SEMS insertion or surgery. Results Although acute complications and stoma formations were lower in the SEMS group than in the surgery group, the clinical efficacy of SEMSs was inferior to emergency surgery (technical success, 73.9% vs 94.2%, P = .001; clinical success, 54.1% vs 75.4%, P = .005). SEMS-related complications occurred in 64.5%, including reobstruction (36.8%), stent migration (10.5%), perforation (13.2%), and bleeding (3.9%). The median duration of patency was not statistically different between the patients who underwent SEMS insertion and those who underwent emergency surgery (117 days vs 183 days, P = .105). Patients with fewer than 2 obstructive sites or less than 2 years to obstructive symptom onset after diagnosis of AGC showed better clinical outcomes after Endoscopic Stenting. Limitations Retrospective and single-center study. Conclusions SEMS insertion seems to be less effective than emergency surgery for the palliation of colorectal obstruction in patients with AGC. Further study is necessary to define those patients with ECM who may benefit from SEMS insertion.
-
long term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers Endoscopic Stenting versus surgery
Gastrointestinal Endoscopy, 2010Co-Authors: Hyun Jung Lee, Byung So Min, Jae Hee Cheon, Tae Il Kim, Nam Kyu Kim, Sung Pil Hong, Won Ho KimAbstract:Background Self-expandable metal stents (SEMSs) provide a promising alternative for initial palliation of malignant bowel obstruction. However, data on the long-term outcomes of SEMSs are limited. Objective The aim of this study was to compare the long-term outcomes of Endoscopic Stenting with those of surgery for palliation in patients with incurable obstructive colorectal cancer. Designs and Setting A retrospective study. Patients From January 2000 to December 2008, patients with incurable obstructive colorectal cancer who were treated with SEMSs (n = 71) or palliative surgery (n = 73) were reviewed. Interventions SEMS placement by using through-the-endoscope methods or surgery. Main Outcome Measurements Success rates and complication rates. Results Early success rates in the SEMS group and those in the surgery group were not different (95.8% vs 100%, P = .12), and the SEMS group had fewer early complications than the surgery group (15.5% vs 32.9%, P = .015). Although the patency duration of the first stent in the SEMS group was shorter than that in the surgery group ( P P = .239). There were more late complications in the SEMS group than in the surgery group ( P = .028), but the rates of major complications did not differ between the 2 groups ( P = .074). Limitations Retrospective and single-center study. Conclusions SEMSs were not only an effective and acceptable therapy for initial palliation of malignant colorectal obstruction, but they also showed long-term efficacy comparable to that with surgery.
Antonio Sterpetti - One of the best experts on this subject based on the ideXlab platform.
-
Complications After Endoscopic Stenting for Malignant Gastric Outlet Obstruction: A Cohort Study.
Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2019Co-Authors: Antonio Sterpetti, Enrico Fiori, Paolo Sapienza, Antonietta LamazzaAbstract:Background:Gastric Stenting has become a common place in clinical practice. The aim of our study was to evaluate the factors influencing the clinical outcome in patients who received Endoscopic Stenting for malignant gastric outlet obstruction (GOO).Materials and Methods:We prospectively evaluated t
-
Endoscopic Stenting for Colorectal Cancer: Lessons Learned From a 15-Year Experience.
Journal of Clinical Gastroenterology, 2018Co-Authors: Enrico Fiori, Antonietta Lamazza, Antonio Sterpetti, Alberto SchillaciAbstract:Goal The aim of our prospective study was to analyze the results of Endoscopic Stenting to treat obstruction due to colorectal cancer and complications after colorectal resection for cancer. Background Endoscopic Stenting for obstructing colorectal cancer has become a common place in clinical practice. However, there is a 2% to 5% risk of bowel perforation, and a percentage of technical failure of 2% to 10%. Materials and methods In a 15-year period (August, 1999 to December, 2013), 153 patients with colorectal cancer had Endoscopic placement of a self-expandable metal stent for treatment of an obstructing colorectal cancer (133 patients) or for treatment of complications after colorectal resection for cancer (20 patients). They were prospectively evaluated in a database and they form the basis of this report. Results There was no case of mortality or major morbidity. Overall technical success was 94.8%. After introducing the use of a pediatric nasogastroscope to pass the obstruction (71 patients), technical success was 100%. Complications in patients in whom the stent was left in place during the follow-up were frequent, requiring a close observation. We had 20 patients with fecal obstruction, 4 cases of stent dislodgment, and 8 cases of obstruction from ingrowth of the tumor. All patients were treated successfully Endoscopically. Conclusions Placement of self-expandable metal stents represents a valid technique. A proper training is required.
-
Factors Leading to Improved Results for Endoscopic Stenting for Metastatic Antropyloric Adenocarcinoma. A Comparison with Gastrojejunostomy
Journal of Gastrointestinal Surgery, 2016Co-Authors: Enrico Fiori, Antonio Sterpetti, Alesando De Cesare, Antonietta LamazzaAbstract:Background Controversies exist about the optimal palliative management for patients with metastatic antropyloric adenocarcinoma. The aim of this study was to analyse the clinical outcome for patients with gastric outlet obstruction syndrome and metastatic antropyloric adenocarcinoma, who underwent Endoscopic Stenting or open gastrojejunostomy, in a prospective not randomised study.
-
Endoscopic Stenting for gastric outlet obstruction in patients with unresectable antro pyloric cancer systematic review of the literature and final results of a prospective study the point of view of a surgical group
American Journal of Surgery, 2013Co-Authors: E Fiori, Antonietta Lamazza, Alberto Schillaci, Ercole Demasi, Alessandro Decesare, Antonio SterpettiAbstract:BACKGROUND: The authors report the final results of a prospective single-center randomized study whose aim was to compare the Endoscopic placement of self-expandable stents with open surgical gastroenterostomy to relieve gastric outlet obstruction (GOO) in patients with advanced antropyloric adenocarcinoma. A systematic review of the medical literature from December 1999 to December 2011 was carried out to determine the results of Endoscopic Stenting in patients with GOO from unresectable primary cancer of the antropyloric region. METHODS: In the prospective study, 18 patients with advanced adenocarcinoma of the antropyloric region and symptoms of GOO were enrolled. In 9 patients, self-expandable stents were placed, and in 9 patients, open surgical gastroenterostomy was performed. Patients were followed until death. Six hundred seventy-two patients with primary unresectable cancer of the antropyloric region and GOO syndrome who underwent Endoscopic Stenting were identified from the literature. RESULTS: In the prospective study of 18 patients, there was no case of postprocedural mortality. Efficient gastric emptying resumed more quickly in patients who received stents, although 3 months after the procedures, there was no difference between the 2 groups. Mean crude survival was 258 days in patients who received stents and 283 days in those who underwent surgical gastroenterostomy (P 5 NS). In patients who underwent stent placement, there were 2 cases of stent migration and 2 cases of food impaction, which were resolved with endoscopy at a mean follow-up of 70 days. In the 672 patients from the literature, operative mortality and morbidity were very low. In prospective studies, complications related to stents were more common than previously thought. CONCLUSIONS: Endoscopic placement of metallic stents offers an effective therapy in patients with advanced primary adenocarcinoma of the antropyloric region and poor general condition. In patients with longer life expectancies, the form of therapy should be chosen individually, considering that surgical gastroenterostomy has fewer complications in the medium term and that in patients with Endoscopic Stenting, very careful follow-up is required, with the possibility of new operative endoscopy in half of the patients.
-
Endoscopic Stenting for gastric outlet obstruction in patients with unresectable antro pyloric cancer. Systematic review of the literature and final results of a prospective study. The point of view of a surgical group
'Elsevier BV', 2013Co-Authors: Enrico Fiori, Antonietta Lamazza, Ercole De Masi, Alessandro De Cesare, Alberto Schillaci, Antonio SterpettiAbstract:BACKGROUND: The authors report the final results of a prospective single-center randomized study whose aim was to compare the Endoscopic placement of self-expandable stents with open surgical gastroenterostomy to relieve gastric outlet obstruction (GOO) in patients with advanced antropyloric adenocarcinoma. A systematic review of the medical literature from December 1999 to December 2011 was carried out to determine the results of Endoscopic Stenting in patients with GOO from unresectable primary cancer of the antropyloric region. METHODS: In the prospective study, 18 patients with advanced adenocarcinoma of the antropyloric region and symptoms of GOO were enrolled. In 9 patients, self-expandable stents were placed, and in 9 patients, open surgical gastroenterostomy was performed. Patients were followed until death. Six hundred seventy-two patients with primary unresectable cancer of the antropyloric region and GOO syndrome who underwent Endoscopic Stenting were identified from the literature. RESULTS: In the prospective study of 18 patients, there was no case of postprocedural mortality. Efficient gastric emptying resumed more quickly in patients who received stents, although 3 months after the procedures, there was no difference between the 2 groups. Mean crude survival was 258 days in patients who received stents and 283 days in those who underwent surgical gastroenterostomy (P = NS). In patients who underwent stent placement, there were 2 cases of stent migration and 2 cases of food impaction, which were resolved with endoscopy at a mean follow-up of 70 days. In the 672 patients from the literature, operative mortality and morbidity were very low. In prospective studies, complications related to stents were more common than previously thought. CONCLUSIONS: Endoscopic placement of metallic stents offers an effective therapy in patients with advanced primary adenocarcinoma of the antropyloric region and poor general condition. In patients with longer life expectancies, the form of therapy should be chosen individually, considering that surgical gastroenterostomy has fewer complications in the medium term and that in patients with Endoscopic Stenting, very careful follow-up is required, with the possibility of new operative endoscopy in half of the patients. (C) 2013 Elsevier Inc. All rights reserved
E Fiori - One of the best experts on this subject based on the ideXlab platform.
-
Endoscopic Stenting for gastric outlet obstruction in patients with unresectable antro pyloric cancer systematic review of the literature and final results of a prospective study the point of view of a surgical group
American Journal of Surgery, 2013Co-Authors: E Fiori, Antonietta Lamazza, Alberto Schillaci, Ercole Demasi, Alessandro Decesare, Antonio SterpettiAbstract:BACKGROUND: The authors report the final results of a prospective single-center randomized study whose aim was to compare the Endoscopic placement of self-expandable stents with open surgical gastroenterostomy to relieve gastric outlet obstruction (GOO) in patients with advanced antropyloric adenocarcinoma. A systematic review of the medical literature from December 1999 to December 2011 was carried out to determine the results of Endoscopic Stenting in patients with GOO from unresectable primary cancer of the antropyloric region. METHODS: In the prospective study, 18 patients with advanced adenocarcinoma of the antropyloric region and symptoms of GOO were enrolled. In 9 patients, self-expandable stents were placed, and in 9 patients, open surgical gastroenterostomy was performed. Patients were followed until death. Six hundred seventy-two patients with primary unresectable cancer of the antropyloric region and GOO syndrome who underwent Endoscopic Stenting were identified from the literature. RESULTS: In the prospective study of 18 patients, there was no case of postprocedural mortality. Efficient gastric emptying resumed more quickly in patients who received stents, although 3 months after the procedures, there was no difference between the 2 groups. Mean crude survival was 258 days in patients who received stents and 283 days in those who underwent surgical gastroenterostomy (P 5 NS). In patients who underwent stent placement, there were 2 cases of stent migration and 2 cases of food impaction, which were resolved with endoscopy at a mean follow-up of 70 days. In the 672 patients from the literature, operative mortality and morbidity were very low. In prospective studies, complications related to stents were more common than previously thought. CONCLUSIONS: Endoscopic placement of metallic stents offers an effective therapy in patients with advanced primary adenocarcinoma of the antropyloric region and poor general condition. In patients with longer life expectancies, the form of therapy should be chosen individually, considering that surgical gastroenterostomy has fewer complications in the medium term and that in patients with Endoscopic Stenting, very careful follow-up is required, with the possibility of new operative endoscopy in half of the patients.
-
management of benign biliary strictures biliary enteric anastomosis vs Endoscopic Stenting
Archives of Surgery, 2000Co-Authors: A Tocchi, Ercole De Masi, G Mazzoni, G Liotta, G Costa, L Lepre, M Miccini, Maria Antonietta Lamazza, E FioriAbstract:Hypothesis Although advances in Endoscopic procedures have provided alternative options for relieving biliary obstructions, the overall chance of cure for patients with benign biliary stricture is the same using surgical or Endoscopic treatment. Design Case-control study. Setting Tertiary care university hospital. Patients Of 163 patients referred for treatment with diagnoses of benign strictures of the common bile duct between January 1, 1975, and July 1, 1998, we studied 42 patients with postcholecystectomy stricture and a follow-up longer than 60 months. Twenty of these patients were treated with Endoscopic Stenting and 22 with surgery (hepaticojejunostomy, choledochojejunostomy, or intrahepatic cholangiojejunostomy). Main Outcome Measures Postoperative mortality and morbility and long-term outcome. The rate of restenosis was also determined. Results Morbidity occurred more frequently in patients treated with Endoscopic procedures than with surgical ones (9 vs 2; P = .34). Hospital mortality was 0%. Surgery achieved excellent or good long-term outcome in 17 of 22 patients. Endoscopic biliary Stenting was successful in 16 of 20 patients. Overall, excellent or good outcomes were achieved in 34 patients (81%). Conclusion The ability to achieve steady, long-term results confirms hepaticojejunostomy as the best procedure in the treatment of benign biliary strictures, even if Endoscopic procedures are gaining a new role in the treatment of a greater number of patients.
Jae Hee Cheon - One of the best experts on this subject based on the ideXlab platform.
-
what is the necessity of endoscopist for successful Endoscopic Stenting in patients with malignant colorectal obstruction
International Journal of Colorectal Disease, 2015Co-Authors: Hyun Jung Lee, Soo Jung Park, Jae Hee Cheon, Tae Il Kim, Won Ho Kim, Sung Pil HongAbstract:Recently, self-expandable metal stents (SEMSs) have been widely used as an initial therapy for relieving malignant colorectal obstructions. However, several factors, including the endoscopist’s experience, affect the clinical outcome of SEMSs. The aim of this study was to define the adequate level of experience necessary to perform Endoscopic Stenting effectively and safely and to identify technical factors for successful Stenting. Between March 2009 and June 2012, 160 patients underwent SEMS placement for malignant colorectal obstruction with the intent of palliation or as a bridge to surgery by a single endoscopist who experienced colonoscopy and Endoscopic retrograde cholangiopancreatography. The overall technical and clinical success rates were 86.9 and 86.4 %, respectively, and 18 complications (11.3 %) were observed. There were no differences in any of the clinical outcomes between the consecutive blocks; however, the procedure time decreased significantly after the first 30 procedures (17.4, 16.9, 13.5, and 12.8 min; P = 0.044). American Society of Anesthesiologists (ASA) class, history of a previous operation, proximal colon obstruction, obstruction caused by an extracolonic malignancy, and palliative SEMS placement were associated with technical failure. An endoscopist who experiences a colonoscopy and fluoroscopy performs SEMS placement successfully regardless of the level of experience. After the first 30 procedures, a SEMS insertion could be safely and effectively performed with short procedure time in patients with malignant colorectal obstruction.
-
What is the necessity of endoscopist for successful Endoscopic Stenting in patients with malignant colorectal obstruction?
International Journal of Colorectal Disease, 2015Co-Authors: Soo Jung Park, Jae Hee Cheon, Sung Pil HongAbstract:Background and aim Recently, self-expandable metal stents (SEMSs) have been widely used as an initial therapy for relieving malignant colorectal obstructions. However, several factors, including the endoscopist’s experience, affect the clinical outcome of SEMSs. The aim of this study was to define the adequate level of experience necessary to perform Endoscopic Stenting effectively and safely and to identify technical factors for successful Stenting. Methods Between March 2009 and June 2012, 160 patients underwent SEMS placement for malignant colorectal obstruction with the intent of palliation or as a bridge to surgery by a single endoscopist who experienced colonoscopy and Endoscopic retrograde cholangiopancreatography. Results The overall technical and clinical success rates were 86.9 and 86.4 %, respectively, and 18 complications (11.3 %) were observed. There were no differences in any of the clinical outcomes between the consecutive blocks; however, the procedure time decreased significantly after the first 30 procedures (17.4, 16.9, 13.5, and 12.8 min; P = 0.044). American Society of Anesthesiologists (ASA) class, history of a previous operation, proximal colon obstruction, obstruction caused by an extracolonic malignancy, and palliative SEMS placement were associated with technical failure. Conclusions An endoscopist who experiences a colonoscopy and fluoroscopy performs SEMS placement successfully regardless of the level of experience. After the first 30 procedures, a SEMS insertion could be safely and effectively performed with short procedure time in patients with malignant colorectal obstruction.
-
The role of primary colectomy after successful Endoscopic Stenting in patients with obstructive metastatic colorectal cancer.
Diseases of the Colon & Rectum, 2014Co-Authors: Hyun Jung Lee, Soo Jung Park, Byung So Min, Jae Hee Cheon, Tae Il Kim, Nam Kyu Kim, Won Ho Kim, Sung Pil HongAbstract:BACKGROUND Although the initial clinical efficacy of self-expandable metal stents is acceptable, doubt still remains about long-term clinical outcomes and complications. OBJECTIVE The aim of this study was to evaluate the stoma formation rate and risk factors for complications after successful Stenting in patients with obstructive metastatic colorectal cancer. DESIGN This was a tertiary-care center retrospective study. PATIENTS From January 2000 to December 2010, 130 patients with unresectable obstructive colorectal cancer received successful self-expandable metal stent placement. Among them, 14 patients received primary colectomy after successful Stenting. INTERVENTIONS Self-expandable metal stent placement and primary colectomy were performed. MAIN OUTCOME MEASURES The stoma formation rate and complications were measured. RESULTS In patients with successful Stenting, stoma formation rates at 1 and 2 years were 15.6% (95% CI, 8.74-22.4) and 24.4% (95% CI, 13.8-35.0), and the median patency duration was 157 days (range, 2-1590 days). However, long-term complications occurred in 58 patients (44.6%), including reobstruction (32.6%), stent migration (10.3%), and perforation (7.8%), and a large number of reinterventions (45.7%) and hospitalizations (37/9%) were needed to manage complications. In multivariate analysis, primary colectomy after successful Endoscopic Stenting was a negative predictive factor for reobstruction (OR, 0.12; 95% CI, 0.02-0.99; p = 0.04). LIMITATIONS This was a retrospective, single-center study. CONCLUSIONS To reduce stent-related late complications, primary colectomy after successful Endoscopic Stenting could be a therapeutic option in patients who have unresectable colorectal cancer with obstruction, especially in those who expect long-term survival.
-
Endoscopic Stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery
Gastrointestinal Endoscopy, 2012Co-Authors: Bo Kyung Kim, Jae Hee Cheon, Tae Il Kim, Sung Pil Hong, Hyun Heo, Jin Young Kim, Hyuk Hur, Kang Young Lee, Won Ho KimAbstract:Background Although self-expandable metal stent (SEMS) insertion has been shown to be an effective therapy for palliation of obstruction from colorectal malignancy, the clinical efficacy of SEMS insertion in the palliation of colorectal obstruction from an extracolonic malignancy (ECM) has not been extensively evaluated. Objective The aim of this study was to evaluate the clinical outcomes and complications of SEMSs compared with those of emergency surgery for relief of colorectal obstruction in patients with advanced gastric cancer (AGC). Design Retrospective study. Patients From January 2000 to December 2009, patients with AGC who were treated with SEMSs (N = 111) or emergency surgery (N = 69) for palliation of malignant colorectal obstruction were included. Intervention SEMS insertion or surgery. Results Although acute complications and stoma formations were lower in the SEMS group than in the surgery group, the clinical efficacy of SEMSs was inferior to emergency surgery (technical success, 73.9% vs 94.2%, P = .001; clinical success, 54.1% vs 75.4%, P = .005). SEMS-related complications occurred in 64.5%, including reobstruction (36.8%), stent migration (10.5%), perforation (13.2%), and bleeding (3.9%). The median duration of patency was not statistically different between the patients who underwent SEMS insertion and those who underwent emergency surgery (117 days vs 183 days, P = .105). Patients with fewer than 2 obstructive sites or less than 2 years to obstructive symptom onset after diagnosis of AGC showed better clinical outcomes after Endoscopic Stenting. Limitations Retrospective and single-center study. Conclusions SEMS insertion seems to be less effective than emergency surgery for the palliation of colorectal obstruction in patients with AGC. Further study is necessary to define those patients with ECM who may benefit from SEMS insertion.
-
long term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers Endoscopic Stenting versus surgery
Gastrointestinal Endoscopy, 2010Co-Authors: Hyun Jung Lee, Byung So Min, Jae Hee Cheon, Tae Il Kim, Nam Kyu Kim, Sung Pil Hong, Won Ho KimAbstract:Background Self-expandable metal stents (SEMSs) provide a promising alternative for initial palliation of malignant bowel obstruction. However, data on the long-term outcomes of SEMSs are limited. Objective The aim of this study was to compare the long-term outcomes of Endoscopic Stenting with those of surgery for palliation in patients with incurable obstructive colorectal cancer. Designs and Setting A retrospective study. Patients From January 2000 to December 2008, patients with incurable obstructive colorectal cancer who were treated with SEMSs (n = 71) or palliative surgery (n = 73) were reviewed. Interventions SEMS placement by using through-the-endoscope methods or surgery. Main Outcome Measurements Success rates and complication rates. Results Early success rates in the SEMS group and those in the surgery group were not different (95.8% vs 100%, P = .12), and the SEMS group had fewer early complications than the surgery group (15.5% vs 32.9%, P = .015). Although the patency duration of the first stent in the SEMS group was shorter than that in the surgery group ( P P = .239). There were more late complications in the SEMS group than in the surgery group ( P = .028), but the rates of major complications did not differ between the 2 groups ( P = .074). Limitations Retrospective and single-center study. Conclusions SEMSs were not only an effective and acceptable therapy for initial palliation of malignant colorectal obstruction, but they also showed long-term efficacy comparable to that with surgery.