Outcomes of colon self-expandable metal stents for malignant vs benign indications at a tertiary care center and review of literature

BACKGROUND Endoscopic placement of a self-expandable metal stent(SEMS)is a minimally invasive treatment for use in malignant and benign colonic obstruction.However,their widespread use is still limited with a nationwide analysis showing only 5.4%of patients with colon obstruction undergoing stent placement.This underutilization could be due to perceived increase risk of complications with stent placement.AIM To review long-and short-term clinical success of SEMS use for colonic obstruction at our center.METHODS We retrospectively reviewed all the patients who underwent colonic SEMS placement over aeighteen year period (August 2004 through August 2022) at our academic center. Demographicsincluding age, gender, indication (malignant and benign), technical success, clinical success,complications (perforation, stent migration), mortality, and outcomes were recorded.RESULTSSixty three patients underwent colon SEMS over an 18-year period. Fifty-five cases were formalignant indications, 8 were for benign conditions. The benign strictures included diverticulardisease stricturing (n = 4), fistula closure (n = 2), extrinsic fibroid compression (n = 1), and ischemicstricture (n = 1). Forty-three of the malignant cases were due to intrinsic obstruction from primaryor recurrent colon cancer;12 were from extrinsic compression. Fifty-four strictures occurred on theleft side, 3 occurred on the right and the rest in transverse colon. The total malignant case (n = 55)procedural success rate was 95% vs 100% for benign cases (P = 1.0, NS). Overall complication ratewas significantly higher for benign group: Four complications were observed in the malignantgroup (stent migration, restenosis) vs 2 of 8 (25%) for benign obstruction (1-perforation, 1-stentmigration) (P = 0.02). When stratifying complications of perforation and stent migration there wasno significant difference between the two groups (P = 0.14, NS).CONCLUSIONColon SEMS remains a worthwhile option for colonic obstruction related to malignancy and has ahigh procedural and clinical success rate. Benign indications for SEMS placement appear to havesimilar success to malignant. While there appears to be a higher overall complication rate inbenign cases, our study is limited by sample size. When evaluating for perforation alone theredoes not appear to be any significant difference between the two groups. SEMS placement may bea practical option for indications other that malignant obstruction. Interventional endoscopistsshould be aware and discuss the risk for complications in setting of benign conditions. Indicationsin these cases should be discussed in a multi-disciplinary fashion with colorectal surgery.

MicroRNA-21 as a potential colon and rectal cancer biomarker

Colorectal cancer(CRC)is one of the most common malignant diseases worldwide and the prognosis is still poor although much progress has been achieved in recent years.In order to reduce CRC-related deaths,many studies are aimed at identifying novel screeningand prognosis-related biomarkers.MicroRNAs(miRNAs)are a class of 18-27-nucleotide single-stranded RNA molecules that regulate gene expression at the posttranscriptional level.It has been demonstrated that miRNAs regulate a variety of physiological functions,including development,cell differentiation,proliferation,and apoptosis.They play important roles in various physiologic and developmental processes and in the initiation and progression of various human cancers.It has been shown that miRNAs can critically regulate tumor cell gene expression,and evidence suggests that they may function as both oncogenes and tumor suppressor genes.In CRC,miRNAs-21 is one of the most important miRNAs and is rapidly emerging as a novel biomarker in CRC,with good potential as a diagnostic and therapeutic target.In this review,we summarize the latest research findings of the clinicopathological relevance of miRNAs-21 in CRC initiation,development,and progress,highlighting its potential diagnostic,prognostic,and therapeutic application,as well as discuss-ing future prospects.