Endoscopic self-expandable metal stent placement before conversion therapy for advanced and recurrent gastrointestinal malignancies

Endoscopic self-expandable metal stent (SEMS) placement is an established palliative treatment for malignant gastrointestinal (GI) obstruction, but data on its use in patients eligible for subsequent conversion therapy remain limited. We describe our single-center experience with SEMS placement in advanced and recurrent GI malignancies and report the proportions of patients who subsequently completed antitumor therapy and underwent R0 resection. We retrospectively reviewed 148 consecutive patients with advanced or recurrent GI malignancies who underwent SEMS placement for malignant obstruction or fistula at a single center between January 2019 and December 2022. Technical success, clinical success, fistula closure, adverse events, subsequent antitumor therapy, R0 resection, and overall survival were assessed. All analyses were descriptive and exploratory; no adjustment for confounding was performed. Gastrointestinal SEMSs were successfully placed in 146 patients (98.6%). The overall obstruction-relief rate was 95.7%, and the overall fistula-closure rate was 80%. No patient in this cohort required rescue gastrostomy or colostomy because of failed stent therapy during the study period. A total of 132 patients (94.3%) completed antitumor treatment after endoscopic metal stent placement (EMSP). R0 resection was performed in 8.89% of patients with esophageal malignancies, 10.10% of those with gastric malignancies, and 17.9% of those with colorectal malignancies. Median survival time (MST) was generally longer among patients who underwent conversion surgery than among those who did not. Comorbidities, anemia, and SEMS-related adverse events were also analyzed as factors associated with conversion therapy after SEMS placement; the respective P values were .039, <.001, and .012. In this retrospective single-center series, SEMS placement was technically feasible and relieved obstruction or closed fistulas in most patients with advanced or recurrent GI malignancies; a subset subsequently completed antitumor therapy and underwent R0 resection. These data support feasibility and demonstrate associations but cannot establish a survival benefit; prospective comparative studies are required.