Comparison of colonic stenting and stoma creation as palliative treatment for incurable malignant colonic obstruction.

Background And Aim: Self-expandable metal stent (SEMS) is a favorable therapeutic option for patients with incurable malignant colonic obstruction (MCO). However, their long-term efficacy and safety compared with those of stoma creation have not been well investigated. This study aimed to compare these long-term outcomes between these two techniques in patients with incurable MCO.

Methods: This retrospective cohort included patients with incurable MCO with SEMS insertion ( = 105) and stoma creation ( = 97) between January 2009 and December 2019. The primary outcomes were patency after the procedure and 1-year re-intervention rates.

Results: The patency of the SEMS group was lower than that of the stoma group (88.9 93.2% at 6 months, 84.1 90.5% at 12 months, and 65.8 90.5% at 18 months; log-rank test,  = 0.024), but 1-year re-intervention rates were not different between the groups (10 8%,  = 0.558). The median patency durations were 190 days for SEMS insertion and 231 days for stoma creation. Majority (84%) of SEMS patients did not require any re-intervention until death. The early complication rate did not differ between the groups ( = 0.377), but SEMS insertion had fewer late minor complications than stoma creation (5 22%,  = 0.001).

Conclusion: SEMS insertion is a safe and effective treatment for patients with incurable MCO. Although SEMS insertion had a lower patency than stoma creation, especially after 1 year, the 1-year re-intervention rates were not different, and SEMS durability was sufficient in most patients.