The Learning Curve for Colorectal Stent Insertion for the Treatment of Malignant Colorectal Obstruction
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Background/Aims: We aimed to assess the effectiveness of self-expanding metal stent (SEMS) insertion by evaluating the learning curve in relation to the experience of an endoscopist. Methods: We retrospectively analyzed the outcomes of 120 SEMS insertion procedures performed by one endoscopist in patients with malignant colorectal obstruction. We compared the technical and clinical success rates, complication rates, and duration of the procedures by quartiles. Results: The mean age of the patients (76 men and 44 women) was 64.6 years. The overall technical success rate was 95.0% (114/120), and the clinical success rate was 90.0% (108/120). The median procedure duration was 16.2 minutes (range, 3.4 to 96.5 minutes). From the first to the last quartile, the technical success rates were 90.0%, 96.7%, 96.7%, and 96.7% (p=0.263), and the clinical success rates were 90.0%, 90.0%, 96.7%, and 83.3% (p=0.588), respectively. Procedure-related complications were observed in 28 patients (23.3%). The complication rates for SEMS insertion when patients were divided by quartiles were 26.7%, 23.3%, 10.0%, and 33.3% (p=0.184), respectively. Moreover, the number of stents per procedure was 1.13, 1.03, 1.00, and 1.00 (p=0.029), respectively. The median duration of SEMS insertion decreased significantly, 20.9 to 14.8 minutes after the first 30 procedures (p=0.005). Conclusions: An experienced endoscopist was able to perform the SEMS insertion procedure easily and effectively after performing 30 SEMS insertions.
Abstract
Background/Aims: We aimed to assess the effectiveness of self-expanding metal stent (SEMS) insertion by evaluating the learning curve in relation to the experience of an endoscopist. Methods: We retrospectively analyzed the outcomes of 120 SEMS insertion procedures performed by one endoscopist in patients with malignant colorectal obstruction. We compared the technical and clinical success rates, complication rates, and duration of the procedures by quartiles. Results: The mean age of the patients (76 men and 44 women) was 64.6 years. The overall technical success rate was 95.0% (114/120), and the clinical success rate was 90.0% (108/120). The median procedure duration was 16.2 minutes (range, 3.4 to 96.5 minutes). From the first to the last quartile, the technical success rates were 90.0%, 96.7%, 96.7%, and 96.7% (p=0.263), and the clinical success rates were 90.0%, 90.0%, 96.7%, and 83.3% (p=0.588), respectively. Procedure-related complications were observed in 28 patients (23.3%). The complication rates for SEMS insertion when patients were divided by quartiles were 26.7%, 23.3%, 10.0%, and 33.3% (p=0.184), respectively. Moreover, the number of stents per procedure was 1.13, 1.03, 1.00, and 1.00 (p=0.029), respectively. The median duration of SEMS insertion decreased significantly, 20.9 to 14.8 minutes after the first 30 procedures (p=0.005). Conclusions: An experienced endoscopist was able to perform the SEMS insertion procedure easily and effectively after performing 30 SEMS insertions.
참고문헌 (20)
- 김태일, "폐쇄성 결장 및 직장암의 위치에 따른 스텐트 삽입술의 효과", 대한소화기학회지, 54(6), pp.413~414 (2009), 대한소화기학회
- 김종수, "폐쇄성 결장 및 직장암에서 폐쇄 병변의 위치에 따른 수술 전 스텐트 삽입술의 효과 비교", 대한소화기학회지, 54(6), pp.384~389 (2009), 대한소화기학회
- Súarez J, "Stent or surgery for incurable obstructive colorectal cancer: an individualized decision", Int J Colorectal Dis, 25, pp.91~96 (2010)
- Nagula S, "Quality of life and symptom control after stent placement or surgical palliation of malignant colorectal obstruction", J Am Coll Surg, 210, pp.45~53 (2010)
- Wong KS, "Treatment of acute malignant colorectal obstruction with self-expandable metallic stents", ANZ J Surg, 72, pp.385~388 (2002)
- Tejero E, "New procedure for the treatment of colorectal neoplastic obstructions", Dis Colon Rectum, 37, pp.1158~1159 (1994)
- Small AJ, "Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors", Gastrointest Endosc, 71, pp.560~572 (2010)
- Tilney HS, "Comparison of colonic stenting and open surgery for malignant large bowel obstruction", Surg Endosc, 21, pp.225~233 (2007)
- Sebastian S, "Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction", Am J Gastroenterol, 99, pp.2051~2057 (2004)
- Khot UP, "Systematic review of the efficacy and safety of colorectal stents", Br J Surg, 89, pp.1096~1102 (2002)
- Dronamraju SS, "Role of self-expanding metallic stents in the management of malignant obstruction of the proximal colon", Dis Colon Rectum, 52, pp.1657~1661 (2009)
- Donnellan F, "Efficacy and safety of colonic stenting for malignant disease in the elderly", Int J Colorectal Dis, 25, pp.747~750 (2010)
- Park S, "Comparison of efficacies between stents for malignant colorectal obstruction: a randomized, prospective study", Gastrointest Endosc, 72, pp.304~310 (2010)
- Tekkis PP, "The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer", Ann Surg, 240, pp.76~81 (2004)
- Goligher JC, "The treatment of acute obstruction or perforation with carcinoma of the colon and rectum", Br J Surg, 45, pp.270~274 (1957)
- Ragland JJ, "Correlation of the prognosis of obstructing colorectal carcinoma with clinical and pathologic variables", Am J Surg, 121, pp.552~556 (1971)
- Yu Kyung Cho, "Clinical Outcome of Self-Expandable Metal Stent Placement in the Management of Malignant Proximal Colon Obstruction", Gut and Liver, 5(2), pp.165~170 (2011), 거트앤리버 발행위원회
- Suh JP, "Effectiveness of stent placement for palliative treatment in malignant colorectal obstruction and predictive factors for stent occlusion", Surg Endosc, 24, pp.400~406 (2010)
- Ely CA, "The use of enteral stents in colonic and gastric outlet obstruction", Surg Endosc, 17, pp.89~94 (2003)
- Williams D, "Colorectal stenting in malignant large bowel obstruction: the learning curve", Int J Surg Oncol, 2011, pp.917848~ (2011)