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 (n = 105) and stoma creation (n = 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 vs 93.2% at 6 months, 84.1 vs 90.5% at 12 months, and 65.8 vs 90.5% at 18 months; log‐rank test, P = 0.024), but 1‐year re‐intervention rates were not different between the groups (10 vs 8%, P = 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 (P = 0.377), but SEMS insertion had fewer late minor complications than stoma creation (5 vs 22%, P = 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.