Large Bowel Obstruction: When Should Colon Stenting Be Considered as First-Line Strategy?
The role of self-expanding metal stents (SEMS) in colonic obstruction continues to evolve. Stenting has been performed by skilled endoscopists throughout the colon. First-line use of SEMS for palliation of obstructing left-sided colon cancer in the face of significant comorbidity is widely accepted. Prophylactic stenting in asymptomatic left-sided colon cancer is not recommended. SEMS in colonic stent decompression as a bridge to elective surgery (SBTS) remains somewhat controversial.
KeywordsColon cancer Rectal cancer Self-expanding metal stents Surgery Endoscopy
- 5.Yang Z, Wu Q, Wang F, Ye X, Qi X, Fan D. A systematic review and meta-analysis of randomized trials and prospective studies comparing covered and bare self-expandable metal stents for the treatment of malignant obstruction in the digestive tract. Int J Med Sci. 2013;10(7):825–35.CrossRefGoogle Scholar
- 15.Arezzo A, Passera R, Lo Secco G, Verra M, Bonino MA, Targarona E, et al. Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc. 2017;86(3):416–26.CrossRefGoogle Scholar
- 23.Ribeiro IB, Bernardo WM, Martins BDC, de Moura DTH, Baba ER, Josino IR, et al. Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis. Endosc Int Open. 2018;6(5):E558–67. Erratum in: Endosc Int Open. 2018;6(5):C1.CrossRefGoogle Scholar
- 26.Hill J, Kay C, Morton D, Magill L, Handley K, Gray RG. CREST Trial Collaborative Group: CREST: Randomised phase III study of stenting as a bridge to surgery in obstructing colorectal cancer-results of the UK ColoRectal Endoscopic Stenting Trial (CREST). J Clin Oncol. 2016;34(Suppl):abstr 3507.CrossRefGoogle Scholar
- 28.Manes G, de Bellis M, Fuccio L, Repici A, Masci E, Ardizzone S, et al. Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent: analysis of results and predictors of outcomes in a large multicenter series. Arch Surg. 2011;146(10):1157–62.CrossRefGoogle Scholar