Outcomes after stenting for malignant large bowel obstruction without radiologist support

AIM: To assess outcomes after colonic stent insertion for obstructing colorectal malignancies performed by an endoscopist without radiologist support.METHODS: This is a retrospective study of all stents inserted by a single surgeon in a District General Hospital over an eight year period. All stents were inserted for patients with acute large bowel obstruction secondary to a malignant colorectal pathology either for palliation or as a bridge to surgery. Procedures were performed by a single surgeon endoscopically with fluoroscopic control in the X-ray department but without the support of an interventional radiologist. Data was collected prospectively on a pre-designed database.RESULTS: The indication for all stent procedures was an obstructing colorectal malignancy. Out of 53 patients, the overall success rate was 90.6%. Eight patients had a stent intended as a bridge to surgery and 45 as a palliative procedure. Technical success was achieved in 50 out of 53 procedures (94.3%) and clinical success in 48 of those remaining 50 (96.0%). Those with unsuccessful technical or clinical procedures went on to have defunctioning stomas to treat their obstruction. There were six complications from the technically successful stents (12.0%). These included one migration, one persisting obstructive symptoms and four cases of tumour overgrowth of the stents at a later date. Haemorrhagic complications, perforation or mortality were not observed in our series. Our results are comparable to several other studies assessing stent outcomes for obstructing bowel cancer.CONCLUSION: Our data suggests that colorectal stents can be inserted without radiologist support by an adequately trained individual with good outcomes.     

Complications and survival in patients undergoing colonic stenting for malignant obstruction

AIM:To investigate whether predicting patients that might be at a higher risk for complications might serve to improve the selection of patients undergoing colonic stenting.METHODS:A retrospective review of consecutive patients who underwent an attempted self-expandable metal stent(SEMS)insertion for malignant colonic obstruction between November 2006 and March 2013.All patients were either referred for preoperative colonic decompression with the intent of a single surgical procedure,or for palliation of the malignant colorectal obstruction for unresectable cancer.Fisher’s test orχ2test was performed on categorical variables,and the t test for continuous variables.Univariable and multivariable logistic regression were used to examine the association between independent variables and the presence of complications from SEMS insertion.RESULTS:SEMS insertion was attempted in 73 patients.Males comprised 55.71%and the mean age was 67.41±12.41 years.Of these,65.15%underwent subsequent surgery,while 34.85%received SEMS as palliation for advanced disease.Extracolonic tumors were only4.76%.The majority of patients had stageⅣdisease(63.83%),while the remainder had stageⅢ(36.17%).SEMS were successfully inserted in 93.85%(95%CI:87.85%-99.85%).Perforations occurred in 4.10%,SEMS migration in 8.21%,and stent re-occlusion from ingrowth occurred in 2.74%of patients.The mean duration of follow up for the patients was 13.52±17.48 mo(range 0-73 mo).None of the variables:age,sex,time between the onset of symptoms to SEMS insertion,time between SEMS insertion and surgery,length of the stenosis,location of the stenosis,albumin level,or receiving neoadjuvant chemotherapy,could predict the development of complications from either SEMS insertion nor prolonged survival.CONCLUSION:None of the variables could predict the development of complications or survival.Further studies are required to identify patients who would benefit the most from SEMS.     

Quality of life in patients with esophageal stenting for the palliation of malignant dysphagia

Incidence of esophageal cancer(EC) is rising more rapidly in the Western world than that of any other cancer. Despite advances in therapy,more than 50% of patients have incurable disease at the time of presentation.This precludes curative treatment and makes palliative treatment a more realistic option for most of these patients. Dysphagia is the predominant symptom in more than 70% of patients with EC and although several management options have been developed in recent years to palliate this symptom,the o...     

Comparison of endoscopic stenting for malignant biliary obstruction: A single-center study

AIM: To evaluate the efficacy and safety of single-step endoscopic placement of self-expandable metallic stents(SEMS) for treatment of obstructive jaundice.METHODS: A retrospective study was performed among 90 patients who underwent transpapillary biliary metallic stent placement for malignant biliary obstruction(MBO) between April 2005 and October 2012. The diagnosis of primary disease and MBO was based on abdominal ultrasound, computed tomography, magnetic resonance imaging, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography with brush cytology, biopsy, and/or a combination of these modalities. The type of SEMS(covered or non-covered, 8 mm or 10 mm in diameter) was determined by the endoscopist. Ninety patients were divided into two groups: group 1(49 patients) who underwent a singlestep SEMS placement and group 2(41 patients) who underwent a two-step SEMS placement. The technical success rate, complication rate, stent patency, and patient survival rate were compared between the groups. In addition, to identify the clinical prognostic factors associated with patient survival, the following variables were evaluated in Cox-regression analysis: gender, age, etiology of MBO(pancreatic cancer or nonpancreatic cancer), clinical stage(Ⅳb; with distant metastases or Ⅳa ; without distant metastases), chemotherapy(with or without), patency of the stent, and the use of single-step or two-step SEMS. RESULTS: Immediate technical success was achieved in 93.9%(46/49) in group 1 and in 95.1%(39/41) in group 2, with no significant difference(P = 1.0). Similarly, there was no difference in the complication rates between the groups(group 1, 4.1% and group 2, 4.9%; P = 0.62). Stent failure was observed in 10 cases in group 1(20.4%) and in 16 cases in group 2(39.0%). The patency of stent and patient survival revealed no difference between the two groups with Kaplan-Meier analysis, with a mean patency of 111 ± 17 d in group 1 and 137 ± 19 d in group 2(P = 0.91), and a mean survival of 178 ± 35 d in group 1 and 222 ± 23 d in group 2(P = 0.57). On the contrary, the number of days of hospitalization associated with first-time SEMS placement in group 1 was shorter when compared with that number in group 2(28 vs 39 d; P 0.05). Multivariate analysis revealed that a clinical stage of Ⅳa (P = 0.0055), chemotherapy(P = 0.0048), and no patency of the stent(P = 0.011) were independent prognostic factors associated with patient survival.CONCLUSION: Our results showed that single-step endoscopic metal stent placement was safe and effective for treating obstructive jaundice secondary to various inoperable malignancies.     

Duodenal stenting for malignant gastric outlet obstruction: prospective study

AIM: To evaluate the results of duodenal stenting for palliation of gastroduodenal malignant obstruction by using a gastric outlet obstruction score (GOOS).METHODS: A prospective, non-randomized study was performed at a tertiary center between August 2005 and April 2010. Patients were eligible if they had malignant gastric outlet obstruction (GOO) and were not candidates for surgical treatment. Medical history and patient demographics were collected at baseline. Scheduled interviews were made on the day of the procedure and 15, 30, 90 and 180 d later or unscheduled as necessary.RESULTS: Fifteen patients (6 male, 9 female; median age 61 years) with GOO who had undergone duodenal stenting were evaluated. Ten patients had metastasis at baseline (66.6%) and 14 were unable to accept oral intake (93.33%), including 7 patients who were using a feeding tube. Laboratory data showed biliary obstruction in eight cases (53.33%); all were submitted to biliary drainage. Two patients developed obstructive symptoms due to tumor ingrowth after 30 d and another due to tumor overgrowth after 180 d. Two cases of stent migration occurred. A good response to treatment was observed, with a mean time of approximately 1 d (19 h) until toleration of a liquid diet and slightly more than 2 d for both soft solids (51 h) and a solid food/normal diet (55 h). The mean time to first failure to maintain liquid intake (GOOS ≥ 1) was 93 d. During follow-up, the mean time to first failure to maintain the previously achieved GOOS of 2-3 (solid/semi-solid food), considered technical failure, was 71 d. On the basis of oral intake a GOOS is defined: 0 for no oral intake; 1 for liquids only; 2 for soft solids only; 3 for low-residue or full diet.CONCLUSION: Enteral stenting to alleviate gastroduodenal malignant obstruction improves quality of life in patients with limited life expectancy, which can be evaluated by using a GOO scoring system.     

A 17 years retrospective study on multiple metal stents for complex malignant hilar biliary strictures: Survival,stents patency and outcomes of re-interventions for occluded metal stents

BackgroundEndoscopic placement of SEMSs for malignant hilar biliary strictures (MHBS) is well-established palliative treatment for inoperable patients. Objectives of this study were evaluation of survival and stents patency after placement of multiple SEMS for palliation of complex MHBS.MethodsRetrospective review of patients with MHBS that underwent ERCP with insertion of multiple SEMSs for palliation. Survival-associated factors and stents patency were analyzed by Cox multivariate analysis.ResultsBetween January 1998 and January 2015, 740 patients with nonoperable MHBS that underwent ERCP were identified and only 18.2% of these received multiple SEMSs. Complications were observed in 7.5% of the patients with no procedure-related mortality. Palliative therapies (chemotherapy, external beam radiotherapy and high dose rate brachytherapy) were done in some patients, and outcomes were evaluated. Overall mean survival of the 134 patients was 323 days. Of these, 59% did not had stents malfunction while 41% patients had episodes of SEMSs malfunction and mean survival after re-interventions was 502.9 days. Survival was not influenced by type of tumor, sex or age.ConclusionsEndoscopic multiple SEMSs placement is safe and effective in patients with complex MHBS. Survival is independent from the type and complexity of MHBS while is prolonged in patients undergoing HDR brachytherapy. Prompt recognition of SEMSs malfunction is fundamental for survival.     

Short- and long-term clinical outcomes of self-expandable metal stents inserted for colorectal obstruction and efficacy of different insertion techniques

Objectives

(1) To evaluate the short- and long-term clinical outcomes of patients after colorectal stent placement and (2) to assess the safety and efficacy of the stents for the resolution of colorectal obstruction according to the insertion technique.

Self-expandable metallic stents for palliation of patients with malignant gastric outlet obstruction caused by stomach cancer

AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review was performed throughout August 2000 to June 2005 of 53 patients with gastric outlet obstruction caused by stomach cancer. All patients had symptomatic obstruction including nausea, vomiting, and decreased oral intake. All received self-expandable metallic stents. RESULTS: Stent implantation was successful in all 53 (100%) patients. Relief of obstructive symptoms was achieved in 43 (81.1%) patients. No immediate stent-related complications were noted. Seventeen patients had recurrent obstruction (tumor ingrowth in 14 patients, tumor overgrowth in 1 patient, and partial distal stent migration in 2 patients). The mean survival was 145 d. Median stent patency time was 187 d. CONCLUSION: Endoscopic placement of self-expandable metallic stents is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.     

Self-expandable metal stents for malignant colonic obstruction: Data from a retrospective regional SIED-AIGO study

BackgroundSelf-expandable metal stents are a non-surgical option for the treatment of symptomatic malignant colorectal obstruction as palliative treatment or as a bridge to surgery.AimsTo report data from a regional study on self-expandable metal stent (SEMS) placement for malignant colorectal obstruction.MethodsTwo hundred and four patients (male 54.9%, mean age of 69.5 ± 14.2) were retrospectively evaluated and data on technical and clinical success, and complications, were analyzed.ResultsTechnical and clinical success rates were 99% and 94.6% respectively, with 36.7% treated on an emergency basis and 63.3% electively. Palliative treatment was administered to 70.1%, and as a bridge to surgery for 29.9%. Complications were 17 neoplastic ingrowths, 10 stent migrations, and 4 perforations. Palliative treatment was associated with a higher risk of stent ingrowth (p = 0.003), and chemotherapy with a lower risk of stent ingrowth (p = 0.009).ConclusionThis regional study, although it has certain limitations, confirms the positive role of self-expandable metal stents in the treatment of symptomatic malignant colorectal obstruction, and that chemotherapy decreases the risk of ingrowth.     

SEMS vs cSEMS in duodenal and small bowel obstruction:High risk of migration in the covered stent group

AIM:To compare clinical success and complications of uncovered self-expanding metal stents(SEMS)vs covered SEMS(cSEMS)in obstruction of the small bowel.METHODS:Technical success,complications and outcome of endoscopic SEMS or cSEMS placement in tumor related obstruction of the duodenum or jejunum were retrospectively assessed.The primary end points were rates of stent migration and overgrowth.Secondary end points were the effect of concomitant biliary drainage on migration rate and overall survival.The data was analyzed according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.RESULTS:Thirty-two SEMS were implanted in 20 patients.In all patients,endoscopic stent implantation was successful.Stent migration was observed in 9 of16 cSEMS(56%)in comparison to 0/16 SEMS(0%)implantations(P=0.002).Stent overgrowth did not significantly differ between the two stent types(SEMS:3/16,19%;cSEMS:2/16,13%).One cSEMS dislodged and had to be recovered from the jejunum by way of laparotomy.Time until migration between SEMS and cSEMS in patients with and without concomitant biliary stents did not significantly differ(HR=1.530,95%CI0.731-6.306;P=0.556).The mean follow-up was 57±71 d(range:1-275 d).CONCLUSION:SEMS and cSEMS placement is safe in small bowel tumor obstruction.However,cSEMS is accompanied with a high rate of migration in comparison to uncovered SEMS.     

Endoscopic stenting for palliation of malignant biliary obstruction

Since the late 1970s, endoscopic biliary stenting has become a standard palliative treatment for obstructive jaundice due to malignancies of the pancreas and the hepatobiliary system. Despite the high initial success rate in achieving biliary drainage, endoscopic stenting therapy has been limited by the clogging of biliary stents, usually after four to five months, due to formation of adherent bacterial biofilm and accumulation of biliary sludge. Various methods for the prevention of bacterial adhesion and prolongation of stent patency have been investigated, including prophylactic antimicrobial agents and bile salts, new stent materials, and new stent designs. Recently, the introduction of self-expandable metal stents has significantly improved the duration of stent patency but the cost is considerably higher. Each method has its own merits as well as specific problems. This article reviews the pathogenesis of biofilm formation on the biliary stents and the latest status of research in avoiding stent occlusion.     

Self-expanding metal stents for the palliation of malignant gastric outlet obstruction in patients with peritoneal carcinomatosis

AIM To evaluate the efficacy of self-expanding metal stents(SEMS) for the palliation of malignant gastric outlet obstruction in patients with and without peritoneal carcinomatosis(PC).METHODS We performed a retrospective analysis of 62 patients who underwent SEMS placement for treatment of malignant gastroduodenal obstruction at our hospital over a six-year period. Stents were deployed through the scope under combined fluoroscopic and endoscopic guidance. Technical success was defined as successful stent placement and expansion. Clinical success was defined as an improvement in the obstructive symptoms and discharge from hospital without additional parenteral nutrition. According to carcinomatosis status, patients were assigned into groups with or without evidence of peritoneal disease.RESULTS In most cases, obstruction was caused by pancreatic(47%) or gastric cancer(23%). Technical success was achieved in 96.8%(60/62), clinical success in 79%(49/62) of all patients. Signs of carcinomatosis were identified in 27 patients(43.5%). The diagnosis was confirmed by pathology or previous operation in 7 patients(11.2%) and suspected by CT, MRI or ultrasound in 20 patients(32.2%). Presence of carcinomatosis was associated with a significantly lower clinical success rate compared to patients with no evidence of peritoneal disease(66.7% vs 88.6%, P = 0.036). There was no significant difference in overall survival between patients with or without PC(median 48 d vs 70 d, P = 0.21), but patients showed significantly longer survival after clinical success of SEMS placement compared to those experiencing clinical failure(median 14.5 d vs 75 d, P = 0.0003).CONCLUSION Given the limited therapeutic options and a clinical success rate of at least 66.7%, we believe that SEMS are a reasonable treatment option in patients with malignant gastric outlet obstruction with peritoneal carcinomatosis.     

Factors Associated with Clinical Outcomes of Palliative Stenting for Malignant Colonic Obstruction

Background/AimsSelf-expandable metal stents (SEMSs) can be applied to relieve colorectal obstruction secondary to incurable primary colorectal cancer or extracolonic malignancy. We aimed to identify factors associated with clinical success and the reintervention-free survival (RFS) after palliative stenting.MethodsCases of palliative SEMS placement between 2005 and 2019 were retrieved from the institutional database and reviewed retrospectively. Logistic regression and log-rank testing followed by Cox proportional hazard analyses were performed to investigate the predictors of the clinical success of palliative stenting and factors associated with RFS, respectively.ResultsA total of 593 patients underwent palliative stenting for malignant colonic obstruction (MCO). The technical and clinical success rates were 92.9% and 83.5%, respectively. Peritoneal carcinomatosis was a predictor of clinical failure (odds ratio, 0.33; 95% confidence interval [CI], 0.17 to 0.65) in the multivariate analysis. Peritoneal carcinomatosis (hazard ratio [HR], 2.48; 95% CI, 1.69 to 3.64) and stent expansion >90% on day 1 (HR, 1.62; 95% CI, 1.05 to 2.50) were associated with a shorter RFS. Neither clinical success nor RFS was associated with extracolonic malignancy. Re-obstruction, stent migration, and perforation were responsible for most reinterventions after clinically successful palliative stenting.ConclusionsIn patients requiring palliative stenting for MCO, peritoneal carcinomatosis was associated with both clinical failure and short RFS. Stent expansion >90% on postprocedural day 1 was another predictor of a short RFS after clinically successful stenting. A large prospective study is warranted to establish factors associated with RFS after successful palliative stenting for MCO.     

Enteral stents for the management of malignant colorectal obstruction

Colorectal cancer (CRC) is the 3^rd most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient’s quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may be used to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient’s condition for curative surgical intervention. An overall complication rate (major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.     

Clinical outcomes and patency of self-expanding metal stents in patients with malignant colorectal obstruction: a prospective single center study

BACKGROUNDS AND AIMS: Self-expanding metal stents (SEMS) have been used as a palliative treatment for malignant colorectal obstruction. However, the reports about primary stent patency rate and associated factors have been limited. This study was performed to evaluate clinical outcomes and factors associated with long-term complications and patency of SEMS in patients with malignant colorectal obstruction. MATERIALS AND METHODS: Patients who underwent palliative endoscopic placement with uncovered SEMS for a malignant colorectal obstruction were prospectively enrolled at Seoul National University Hospital between April 2005 and August 2007. RESULTS: Forty-nine patients underwent 51 SEMS placements. Obstruction sites were rectum in 15 patients (30.6%), descending or sigmoid colon in 25 (51.0%), and transverse colon in nine (18.4%), respectively. The causes of obstruction were colorectal cancer in 36 patients (73.5%), direct invasion of gastric cancer in seven (14.3%) and others in six (12.2%). Technical success was achieved in 100% and clinical success in 86%, and there was one procedure-related perforation. Re-obstruction and migration occurred in 16% and 6%, respectively, during mean follow-up period of 331 days. Median stent patency duration was 204 days, and patency rates at 30, 90, and 180 days were 91.2%, 81.0%, and 53.3%, respectively, which was not associated with patient demographics, site of obstruction, or palliative chemotherapy. CONCLUSION: Endoscopic SEMS placement is a safe and effective palliative treatment for malignant colorectal obstruction, and overall long-term complication and patency were favorable irrespective of the palliative chemotherapy.     

Self-expandable metallic stent placement plus laparoscopy for acute malignant colorectal obstruction

AIM:To investigate the clinical advantages of the stent-laparoscopy approach to treat colorectal cancer(CRC)patients with acute colorectal obstruction(ACO).METHODS:From April 2008 to April 2012,surgeryrelated parameters,complications,overall survival(OS),and disease-free survival(DFS)of 74 consecutive patients with left-sided CRC presented with ACO who underwent self-expandable metallic stent(SEMS)placement followed by one-stage open(n=58)or laparoscopic resection(n=16)were evaluated retrospectively.The stent-laparoscopy group was also compared with a control group of 96 CRC patients who underwent regular laparoscopy without ACO between January 2010 and December 2011 to explore whether SEMS placement influenced the laparoscopic procedure or reduced long-term survival by influencing CRC oncological characteristics.RESULTS:The characteristics of patients among these groups were comparable.The rate of conversion to open surgery was 12.5%in the stent-laparoscopy group.Bowel function recovery and postoperative hospital stay were significantly shorter(3.3±0.9 d vs 4.2±1.5 d and 6.7±1.1 d vs 9.5±6.7 d,P=0.016 and P=0.005),and surgical time was significantly longer(152.1±44.4 min vs 127.4±38.4 min,P=0.045)in the stent-laparoscopy group than in the stent-open group.Surgery-related complications and the rate of admission to the intensive care unit were lower in the stent-laparoscopy group.There were no significant differences in the interval between stenting and surgery,intraoperative blood loss,OS,and DFS between the two stent groups.Compared with those in the stentlaparoscopy group,all surgery-related parameters,complications,OS,and DFS in the control group were comparable.CONCLUSION:The stent-laparoscopy approach is a feasible,rapid,and minimally invasive option for patients with ACO caused by left-sided CRC and can achieve a favorable long-term prognosis.     

Outcome of stenting in biliary and pancreatic benign and malignant diseases: A comprehensive review

Endoscopic stenting has become a widely method for the management of various malignant and benign pancreatico-biliary disorders. Biliary and pancreatic stents are devices made of plastic or metal used primarily to establish patency of an obstructed bile or pancreatic duct and may also be used to treat biliary or pancreatic leaks, pancreatic fluid collections and to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis. In this review, relevant literature search and expert opinions have been used to evaluate the outcome of stenting in biliary and pancreatic benign and malignant diseases.     

金属支架治疗肠道恶性梗阻的临床研究

目的探讨金属自膨式支架治疗肠道恶性梗阻的临床疗效及意义。方法对1999年至今我院消化科门诊和住院的31例肠道恶性梗阻患者进行金属自膨式支架置入术。结果31例均放置成功，患者恶心、呕吐、排便困难等梗阻症状得到缓解，生活质量得到提高。结论金属自膨式支架无论是在肠道恶性梗阻无法手术、手术后复发还是在肿瘤切除术后吻合口狭窄等情况下，均可解决梗阻，达到提高患者生存质量的目的。     

Palliative treatment for incurable malignant colorectal obstructions: A meta-analysis

AIM:To perform a meta-analysis of palliative stent placement vs palliative surgical decompression for management of incurable malignant colorectal obstructions.METHODS:The databases of Medline,Web of Science,Embase,and the Cochrane Central Register of Controlled Trials were searched from their inception to July 2012 for studies(prospective,retrospective,randomized controlled trials,and case-control trials)designed as comparative analyses of patients with incurable malignant colorectal obstructions treated by selfexpanding metallic stents(SEMS)or palliative surgery.No language restrictions were imposed.The main outcome measures were hospital stay,intensive care unit admission,clinical success rate,30-d mortality,stoma formation,complications,and overall survival time.The data extraction was conducted by two investigators working independently and using a standardized form.The Mantel-Haenszel 2method was used to estimate the pooled risk ratios with 95%CI under a fixed-effects model;when statistical heterogeneity existed in the pooled data(as evaluated by Q test and I2statistics,where P<0.10 and I2<25%indicated heterogeneity),a random-effects model was used.RESULTS:Thirteen relevant articles,representing837 patients(SEMS group,n=404;surgery group,n=433),were selected for analysis.Compared to the surgery group,the SEMS group showed lower clinical success(99.8%vs 93.1%,P=0.0009)but shorter durations of hospital stay(18.84 d vs 9.55 d,P<0.00001)and time to initiation of chemotherapy(33.36 d vs15.53 d,P<0.00001),and lower rate of stoma formation(54.0%vs 12.7%,P<0.00001).Additionally,the SEMS group experienced a significantly lower rate of30-d mortality(4.2%vs 10.5%,P=0.01).Stent-related complications were not uncommon and included perforation(10.1%),migration(9.2%),and occlusion(18.3%).Surgery-related complications were slightly less common and included wound infection(5.0%)and anastomotic leak(4.7%).The rate of total complications was similar between these two groups(SEMS:34.0%vs surgery:38.1%,P=0.60),b     

Using stents in the management of malignant bowel obstruction: the current situation and future progress

Introduction: The use of self-expanding metal stents (SEMS) has been considered an effective and safe alternative to emergency surgery as bridge to surgery or for palliation in advanced colorectal cancer even though more recent data have raised concerns on both early and long-term outcomes when patients are treated with bridge to surgery indications.

Areas covered: A comprehensive literature review of articles on endoscopic management of malignant bowel obstruction was performed. Indication, technique, outcomes, benefits and risks of these treatments in acute malignant colonic obstruction were reviewed. The clinical effectiveness and safety of SEMS in obstructive colorectal cancer, as bridge to surgery or for palliation compared to surgery, is discussed.

Expert commentary: SEMS placement, when performed in tertiary level center with appropriate expertise in colorectal stenting, may have several advantages over surgery avoiding the potential for surgical morbidity in a typically frail group of patients even though these advantages are to be carefully balanced over the risk of life-threatening, stent-related complications.