Advertisement

Large Bowel Obstruction: When Should Colon Stenting Be Considered as First-Line Strategy?

  • George Melich
  • Elena Vikis
  • Alberto Arezzo
Chapter

Abstract

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.

Keywords

Colon cancer Rectal cancer Self-expanding metal stents Surgery Endoscopy 

References

  1. 1.
    Rupp KD, Dohmoto M, Meffert R, Holzgreve A, Hohlbach G. Cancer of the rectum- palliative endoscopic treatment. Eur J Surg Oncol. 1995;21(6):644–7.CrossRefGoogle Scholar
  2. 2.
    Tejero E, Mainar A, Fernández L, Tobío R, De Gregorio MA. New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum. 1994;37(11):1158–9.CrossRefGoogle Scholar
  3. 3.
    Flor-Lorente B, Báguena G, Frasson M, García-Granero A, Cervantes A, Sanchiz V, et al. Self-expanding metallic stent as a bridge to surgery in the treatment of left colon cancer obstruction: Cost-benefit analysis and oncologic results. Cir Esp. 2017;95(3):143–51.CrossRefGoogle Scholar
  4. 4.
    Zhang Y, Shi J, Shi B, Song CY, Xie WF, Chen YX. Comparison of efficacy between uncovered and covered self-expanding metallic stents in malignant large bowel obstruction: a systematic review and meta-analysis. Colorectal Dis. 2012;14(7):e367–74.CrossRefGoogle Scholar
  5. 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
  6. 6.
    Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc. 2010;71(3):560–72.CrossRefGoogle Scholar
  7. 7.
    Kim BC, Han KS, Hong CW, Sohn DK, Park JW, Park SC, et al. Clinical outcomes of palliative self-expanding metallic stents in patients with malignant colorectal obstruction. J Dig Dis. 2012;13(5):258–66.CrossRefGoogle Scholar
  8. 8.
    Im JP, Kim SG, Kang HW, Kim JS, Jung HC, Song IS. Clinical outcomes and patency of self-expanding metal stents in patients with malignant colorectal obstruction: a prospective single center study. Int J Colorectal Dis. 2008;23(8):789–94.CrossRefGoogle Scholar
  9. 9.
    Baron TH, Wong Kee Song LM, Repici A. Role of self-expandable stents for patients with colon cancer (with videos). Gastrointest Endosc. 2012 Mar;75(3):653–62.CrossRefGoogle Scholar
  10. 10.
    ASGE Standards of Practice Committee, Fisher DA, Shergill AK, Early DS, Acosta RD, Chandrasekhara V, et al. Role of endoscopy in the staging and management of colorectal cancer. Gastrointest Endosc. 2013;78(1):8–12. Erratum in: Gastrointest Endosc. 2013;78(3):559.CrossRefGoogle Scholar
  11. 11.
    van Hooft JE, van Halsema EE, Vanbiervliet G, Beets-Tan RGH, DeWitt JM, Donnellan F. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Gastrointest Endosc. 2014;80(5):747–61.CrossRefGoogle Scholar
  12. 12.
    Ferrada P, Patel MB, Poylin V, Bruns BR, Leichtle SW, Wydo S, et al. Surgery or stenting for colonic obstruction: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2016;80(4):659–64.CrossRefGoogle Scholar
  13. 13.
    Pisano M, Zorcolo L, Merli C, Cimbanassi S, Poiasina E, Ceresoli M, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg. 2018;13:36.CrossRefGoogle Scholar
  14. 14.
    van Hooft JE, Bemelman WA, Oldenburg B, Marinelli AW, Lutke Holzik MF, Grubben MJ, et al. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol. 2011;12(4):344–52.CrossRefGoogle Scholar
  15. 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
  16. 16.
    Cheung HY, Chung CC, Tsang WW, Wong JC, Yau KK, Li MK. Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial. Arch Surg. 2009;144(12):1127–32.CrossRefGoogle Scholar
  17. 17.
    Ghazal AH, El-Shazly WG, Bessa SS, El-Riwini MT, Hussein AM. Colonic endolumenal stenting devices and elective surgery versus emergency subtotal/total colectomy in the management of malignant obstructed left colon carcinoma. J Gastrointest Surg. 2013;17(6):1123–9.CrossRefGoogle Scholar
  18. 18.
    Alcántara M, Serra-Aracil X, Falcó J, Mora L, Bombardó J, Navarro S. Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg. 2011;35(8):1904–10.CrossRefGoogle Scholar
  19. 19.
    Ho KS, Quah HM, Lim JF, Tang CL, Eu KW. Endoscopic stenting and elective surgery versus emergency surgery for left-sided malignant colonic obstruction: a prospective randomized trial. Int J Colorectal Dis. 2012;27(3):355–62.CrossRefGoogle Scholar
  20. 20.
    Pirlet IA, Slim K, Kwiatkowski F, Michot F, Millat BL. Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc. 2011;25(6):1814–21.CrossRefGoogle Scholar
  21. 21.
    Arezzo A, Balague C, Targarona E, Borghi F, Giraudo G, Ghezzo L, et al. Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial). Surg Endosc. 2017;31(8):3297–305.CrossRefGoogle Scholar
  22. 22.
    Allievi N, Ceresoli M, Fugazzola P, Montori G, Coccolini F, Ansaloni L. Endoscopic stenting as bridge to surgery versus emergency resection for left-sided malignant colorectal obstruction: an updated meta-analysis. Int J Surg Oncol. 2017;2017:2863272.PubMedPubMedCentralGoogle Scholar
  23. 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
  24. 24.
    Erichsen R, Horváth-Puhó E, Jacobsen JB, Nilsson T, Baron JA, Sørensen HT. Long-term mortality and recurrence after colorectal cancer surgery with preoperative stenting: a Danish nationwide cohort study. Endoscopy. 2015;47(6):517–24.CrossRefGoogle Scholar
  25. 25.
    Ceresoli M, Allievi N, Coccolini F, Montori G, Fugazzola P, Pisano M, et al. Long-term oncologic outcomes of stent as a bridge to surgery versus emergency surgery in malignant left side colonic obstructions: a meta-analysis. J Gastrointest Oncol. 2017;8(5):867–76.CrossRefGoogle Scholar
  26. 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
  27. 27.
    Repici A, de Paula Pessoa Ferreira D. Expandable metal stents for malignant colorectal strictures. Gastrointest Endosc Clin N Am. 2011;21(3):511–33.CrossRefGoogle Scholar
  28. 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
  29. 29.
    Cennamo V, Fuccio L, Mutri V, Minardi ME, Eusebi LH, Ceroni L, et al. Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy? Clin Gastroenterol Hepatol. 2009;7(11):1174–6.CrossRefGoogle Scholar
  30. 30.
    Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc. 2010;71(3):560–72.CrossRefGoogle Scholar
  31. 31.
    Yoon JY, Jung YS, Hong SP, Kim TI, Kim WH, Cheon JH. Clinical outcomes and risk factors for technical and clinical failures of self-expandable metal stent insertion for malignant colorectal obstruction. Gastrointest Endosc. 2011;74(4):858–68.CrossRefGoogle Scholar
  32. 32.
    Branger F, Thibaudeau E, Mucci-Hennekinne S, Métivier-Cesbron E, Vychnevskaia K, Hamy A, et al. Management of acute malignant large-bowel obstruction with self-expanding metal stent. Int J Colorectal Dis. 2010;25(12):1481–5.CrossRefGoogle Scholar
  33. 33.
    de Gregorio MA, Mainar A, Rodriguez J, Alfonso ER, Tejero E, Herrera M, et al. Colon stenting: a review. Semin Intervent Radiol. 2004;21(3):205–16.CrossRefGoogle Scholar
  34. 34.
    Melich G, Pai A, Balachandran B, Marecik SJ, Prasad LM, Park JJ. Endoscopic control of enterocutaneous fistula by dual intussuscepting stent technique. Surg Endosc. 2016;30(9):4150–1.CrossRefGoogle Scholar
  35. 35.
    Kim BC, Han KS, Hong CW, Sohn DK, Park JW, Park SC, et al. Clinical outcomes of palliative self-expanding metallic stents in patients with malignant colorectal obstruction. J Dig Dis. 2012;13(5):258–66.CrossRefGoogle Scholar
  36. 36.
    Lee YJ, Yoon JY, Park JJ, Park SJ, Kim JH, Youn YH, et al. Clinical outcomes and factors related to colonic perforations in patients receiving self-expandable metal stent insertion for malignant colorectal obstruction. Gastrointest Endosc. 2018;87(6):1548–57.CrossRefGoogle Scholar
  37. 37.
    Lee JH, Yoon JY, Park SJ, Hong SP, Kim TI, Kim WH, et al. The learning curve for colorectal stent insertion for the treatment of malignant colorectal obstruction. Gut Liver. 2012;6(3):328–33.CrossRefGoogle Scholar
  38. 38.
    Cui J, Zhang JL, Wang S, Sun ZQ, Jiang XL. A preliminary study of stenting followed by laparoscopic surgery for obstructing left-sided colon cancer [Article in Chinese]. Zhonghua Wei Chang Wai Ke Za Zhi. 2011;14(1):40–3.PubMedGoogle Scholar

Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2020

Authors and Affiliations

  • George Melich
    • 1
    • 2
  • Elena Vikis
    • 1
    • 2
  • Alberto Arezzo
    • 3
  1. 1.Royal Columbian Hospital, Department of General SurgeryNew WestminsterCanada
  2. 2.University of British Columbia, Department of General SurgeryNew WestminsterCanada
  3. 3.Department of Surgical SciencesUniversity of TorinoTorinoItaly

Personalised recommendations