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, 6 (3), 328-33

The Learning Curve for Colorectal Stent Insertion for the Treatment of Malignant Colorectal Obstruction


The Learning Curve for Colorectal Stent Insertion for the Treatment of Malignant Colorectal Obstruction

Ji Hoon Lee et al. Gut Liver.


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.

Keywords: Colorectal neoplasms; Colorectal stents; Learning curve; Malignant colorectal obstruction; Self-expanding metallic stents.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.


Fig. 1
Fig. 1
(A) Technical success rate. (B) Clinical success rate. (C) Procedure duration. (A) and (B) illustrate the learning curves for colorectal self-expanding metal stents insertion, which reveal correlations between technical success rates (A), clinical success rates (B), and the endoscopist's level of experience (p>0.05). (C) It demonstrates the correlation between procedure duration and level of experience. The median procedure duration decreased significantly after the first 30 procedures (p<0.05 with the multiple comparison test [Dunn procedure]).

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