Stenting for obstructing colorectal malignancy: an interim or definitive procedure

Background: The purpose of this paper is to review and report our experience with colorectal stenting in the management of malignant large bowel obstruction. Methods: Twelve consecutive patients with malignant left‐sided large bowel obstruction between June 1998 and January 2001 underwent insertion of self‐expanding metallic stents. One patient required two stents. Eight stents were inserted under fluoroscopic guidance, and five were inserted with combined fluoroscopic and endoscopic guidance. Patients were followed up until death, stent removal or the time of publication. Results: Thirteen stents were inserted. Eleven patients with acute large bowel obstruction had relief of obstruction with stenting, and one of these patients required a second stent because relief had been incomplete. One patient was stented in order to sub­sequently close a problematic stoma. Technical success was 92.9% and clinical success was 100%. Three patients proceeded to surgical resection. In nine patients, the stent was left as the definitive procedure. Of these, six patients have died within 4 months. Complications included one case of migration, one case of reobstruction, one intestinal haematoma and one case of cheesewiring. Conclusions: Colorectal stenting is an important treatment modality for malignant large bowel obstruction. It may be definitive treatment alone, or a bridge to elective surgical resection.     

Surgery after colonic stenting

Colonic stenting is an accepted treatment of large bowel obstruction. The literature is sparse regarding surgical difficulties associated with an indwelling stent. We report our experience focusing on outcomes, complications, and whether the stent created intraoperative concerns. In this retrospective review, 6 patients were identified between 2007 and 2010 that had surgery after colonic stents were placed. Their charts were reviewed to compare clinical variables, surgical procedures, outcomes, and complications. One obstruction was due to diverticulitis. The stent reobstructed, leading to emergent transverse loop colostomy, and subsequent sigmoidectomy with stoma reversal. Four patients' obstructing masses were malignant. The final patient's stent was placed through a Hartmann's stump to drain a pelvic abscess. These 5 patients had no stent complications. Surgery occurred an average of 9.8 weeks after stent placement; four had low anterior resections and one underwent Hartmann's reversal. All 6 patients had colorectal anastomoses and five underwent laparoscopic surgery; one had an anastomotic leak requiring reoperation. Colonic stenting allows for the immediate relief of obstruction while permitting diagnosis and treatment of coexisting medical problems. The colon can be prepared for an elective rather than emergency operation, and a colostomy may be avoided.     

Acute endometrial bowel obstruction—A rare indication for colonic stenting

INTRODUCTIONPelvic endometriosis is an extremely rare cause of large bowel obstruction and the management can be challenging. Urgent surgery for acute colonic obstruction is known to carry high morbidity and mortality, and operation may be made more difficult in extensive pelvic endometriosis. Less invasive alternatives in the acute situation may need to be considered.PRESENTATION OF CASEPresented is the case of a 35-year-old lady with obstructive bowel symptoms caused by an endometriotic upper rectal stricture. She was initially treated using radiologically guided stent insertion, as an acute intervention, prior to an elective bowel resection and hysterectomy with bilateral salpingo-oophorectomy.DISCUSSIONColonic stenting is currently widely used in malignant obstruction. The use of self expanding metallic stents (SEMS) to treat benign conditions is controversial, however, due to associated long term complications. This case demonstrates that stenting can provide a bridge to major surgery in the rare event of acute endometriotic colonic obstruction. The initial acute treatment with stenting provides the advantage of time to involve the multi-disciplinary team, to medically optimise the patient and to better plan the definitive surgery.CONCLUSIONThe use of radiologically guided stents has a place in the treatment of benign recto-sigmoid obstruction due to endometriosis and therefore should be considered as a bridge to further surgical treatment.     

Long-term results of palliative stenting or surgery for incurable obstructing colon cancer

Objective  Self-expanding metal stents are an effective means of relieving left-sided malignant colonic obstruction, and in the setting of incurable disease may provide palliation while allowing the patients to avoid surgery altogether. With modern chemotherapy regimes, patients may have a long-life expectancy, even in the presence of metastases. The purpose of this study was to investigate the long-term results of palliative stent placement, compared with patients undergoing palliative surgery.
Method  This is a retrospective study of 55 consecutive patients who underwent colonic stenting or palliative surgery for incurable, obstructing adenocarcinoma of the left colon.
Results  Twenty-nine patients underwent colonic stenting, and 26 had surgery during the study period. Survival was similar in the two groups (14 months in the stent group, 11 months in the surgery group). Median hospital stay was shorter in the stent group (4 vs 13.5 days), and fewer patients in the stent group had complications (2 vs 14). Only four patients in the stent group went on to require later surgery. The median time to failure of the stents was 14 months.
Conclusion  Colonic stenting provides effective and durable palliation for patients with incurable, obstructing adenocarcinomas of the left colon. It can be performed with less morbidity than palliative surgery, and offers similar long-term survival.     

Management of the neoplastic stenosis of the left colon with self-expandable endoprosthesis

Malignant tumors of the large bowel develop colonic obstruction in 10-30% cases. Recently many authors have employed self-expandable stents to resolve the colonic obstruction. During 2002, seven patients affected by neoplastic malignant stenosis of the left colon underwent endoscopic placement of self-expandable enteral stent. The technique succeeded in relieving the obstruction in 6 patients, while in a woman affected by malignant tumor of the splenic flexure, colonic stenting was unsuccessful. The Authors didn't observe any procedure related complications; sign and symptoms of intestinal obstruction resolved within 24-72 hours from placement. Four patients needed hydro-electrolitemic correction, intestinal cleaning and R0 resection with one stage anastomosis within 5 and 9 days. Bowel decompression of the neoplastic stenosis relieved by self expandable metallic stents is useful to avoid emergency surgery and provide time for a complete preoperative staging, a metabolic correction and a mechanical bowel preparation. Complications of stent placement are common in many reports and include minor rectal bleeding (2%) and perforations (4%). Stenting is contraindicated in cases of enlarged colon with diameter superior to 8 cm or in flogistic lesions.     

The management of neoplastic colorectal obstruction with colonic endolumenal stenting devices

BACKGROUND: Colonic endolumenal stenting (CELS) to treat obstructing colorectal neoplasms was first described in 1991. The aim of this study was to review the published world literature and make recommendations for its use in current clinical practice. METHODS: Suitable English language reports were identified using a Medline search. RESULTS: CELS can been successfully accomplished in 64% to 100% of obstructing malignant colonic lesions. Distal lesions are more common and theoretically more easy to stent although lesions within the ascending colon have been successfully managed. Minor complications include transient anorectal pain and rectal bleeding, however, significant complications of stent dislocation and colonic perforation are also well recognized. CONCLUSION: CELS can aid the palliative management of malignant colorectal obstruction. Its role in relieving obstruction prior to resection remains to be defined. Increasing experience has allowed the safe placement of stents and relief of obstruction of virtually any lesion throughout the large bowel.     

Management of obstructive colorectal cancer with endoscopic stenting followed by single-stage surgery: open or laparoscopic resection?

BACKGROUND: About one-third of patients with colorectal carcinoma present with acute colonic obstruction requiring emergency surgery. Current surgical options are intraoperative lavage and resection of the colonic segment involved with primary anastomosis, subtotal colectomy with primary anastomosis, colostomy followed by resection, and resection of the colonic segment involved with end colostomy (Hartmann's procedure) requiring a second operation to reconstruct the colon. These procedures present risks and a poor quality of life. Endoscopic colonic stent insertion can effectively decompress the obstructed colon, allowing bowel preparation and elective resection. METHODS: The authors present their experience managing 31 patients with obstructing colorectal cancer who underwent endoscopic colonic decompression with self-expanding metallic stents. A total of 16 patients were treated with open resection, and 6 underwent a laparoscopic resection. The remaining 9 patients were managed with endoscopic palliation and adjuvant therapy. Of the 31 patients, 17 were treated with postoperative chemotherapy. RESULTS: The mean interval between stenting and surgery was 11 days (range, 1-21 days). There was no intraoperative morbidity. The incidence of postoperative morbidity was 20% for open surgery and 0% for laparoscopic surgery. The mean postoperative hospital stay was 13 days for the open surgery group, and 7 days for the laparoscopic group (p = 0.003). The hospital mortality rate was 3.2%. Follow-up evaluation was completed for 96% of the patients. The minimum follow-up period was 15 months. All the patients in the palliative group died of disease, with a median survival of 3 months. Of the 22 surgically treated patients, 17 (77%) are alive at this writing. CONCLUSION: This initial experience shows that after successful endoscopic stenting of malignant colorectal obstruction, elective surgical resection can be performed safely. The presence of the endoluminal stent does not prevent a laparoscopic approach. The combined endoscopic and laparoscopic procedures are a less invasive alternative to the multistage open operations and offer a faster recovery.     

Endoluminal stenting for benign colonic obstruction

We report a case of complete descending colon obstruction due to diverticular disease that was initially managed by endoscopic stent placement followed by single-stage left colectomy with primary anastomosis. Traditional management of complete large bowel obstruction, whether due to benign or malignant disease, most often requires a temporary colostomy because of unprepared colon. In this case, preparation of the colon was accomplished by successful stenting of the benign colonic obstruction. We believe that endoscopic colonic stenting is an effective way of avoiding a temporary colostomy in patients with complete large bowel obstruction. Received: 10 June 1997/Accepted: 1 July 1997     

Self-expanding metallic stent insertion in the proximal colon

Objective Colonic obstruction may be relieved by the insertion of a self‐expanding metallic stent (SEMS), either for permanent palliative relief or as a bridge to surgery. Lesions proximal to the descending colon can be more difficult to intubate and stent [ 1 ]. SEMS placement in the more proximal colon lesions has been reported in only a few cases [ 2 , 4 ]. The aim of this study was to review the outcome of SEMS for obstruction at the splenic flexure and above. Method A study of all colonic stents inserted in one specialist unit was undertaken. Patients’ demographics, site and aetiology of the underlying obstruction, success or other outcome of the procedures were collected. Thirty‐day morbidity and mortality were documented. Results Seven patients had proximal lesions: four in the transverse colon and three at the splenic flexure. Six patients had colorectal carcinoma and one had extrinsic compression from a gastric carcinoma. Six of the SEMS were inserted for permanent palliation, and one as a bridge to surgery. Stent placement was technically successful in six of the seven patients. In the seventh patient, there was a failure of expansion of the stent, after successful intubation of the lesion, which was in the distal transverse colon. One patient suffered from minor self‐limiting abdominal pain in the first 24 h after the procedure. There was no other SEMS related morbidity or mortality. All of the successfully stented patients were discharged from the surgical ward within 3 days after the procedure. Median survival time was 4.3 months (range 3–12 months). Three patients are still alive. Conclusion The SEMS is a useful tool in managing acute bowel obstruction. Placement of colonic stents proximal to the descending colon is safe, feasible and effective.     

Treatment of acute malignant colorectal obstruction with self-expandable metallic stents

Background: Malignant left‐sided large bowel obstruction from intraluminal and extrinsic causes constitutes a surgical emergency. When conservative measures fail, emergent surgery is usually required, which carries increased morbidity and mortality compared with elective resections. In many situations, a stoma is created and further surgery may be required later to re‐establish bowel continuity. We present an initial series of patients in whom self‐expandable metallic stents (SEMS) were deployed to allow bowel decompression in place of emergency surgery for acute left‐sided colorectal obstruction. Methods: From April 1999 to January 2001, patients who were admitted to the colorectal unit with clinical and radiological features of intestinal obstruction were considered for endolumenal stenting. Stenting was performed under radiological guidance. Results: Sixteen patients underwent endolumenal stenting (age range: 23?90 years, eight men and eight women). There were two technical failures, two delayed perforations and one sealed perforation related to the stent. Three patients underwent elective resection and anastomosis after successful bowel decompression and mechanical bowel preparation. Eight patients with advanced malignancy or multiple medical disease had good bowel decompression after stent deployment and did not undergo any surgery. Conclusion: SEMS is a useful alternative in the management of acute left‐sided colorectal obstruction for a select group of patients. An algorithm for management of acute left‐sided large bowel obstruction incorporating the use of SEMS is proposed.     

Comparison of colonic stenting and open surgery for malignant large bowel obstruction

Background Colonic stents potentially offer effective palliation for those with bowel obstruction attributable to incurable malignancy, and a “bridge to surgery” for those in whom emergency surgery would necessitate a stoma. The current study compared the outcomes of stents and open surgery in the management of malignant large bowel obstruction. Methods A literature search of the Medline, Ovid, Embase and Cochrane databases was performed to identify comparative studies reporting outcomes on colonic stenting and surgery for large bowel obstruction. Random effects meta-analytical techniques were applied to identify differences in outcomes between the two groups. Sensitivity analysis of high quality studies, those reporting on more than 35 patients, those solely concerning colorectal cancer and studies performing intention to treat analysis was undertaken to evaluate the study heterogeneity. Results A total of 10 studies satisfied the criteria for inclusion, with outcomes reported for 451 patients. Stent insertion was attempted for 244 patients (54.1%), and proved successful for 226 (92.6%). The length of hospital stay was shorter by 7.72 days in the stent group (p < 0.001), which also had lower mortality (p = 0.03) and fewer medical complications (p < 0.001). Stoma formation at any point during management was significantly lower than in the stent group (odds ratio, 0.02; p < 0.001), and “bridging to surgery” did not adversely influence survival. Conclusions Colonic stenting offers effective palliation for malignant bowel obstruction, with short lengths of hospital stay and a low rate for stoma formation, but data on quality of life and economic evaluation are limited. There is no evidence of differences in long-term survival between those who have stents followed by subsequent resection and those undergoing emergency bowel resection. This paper was presented as an oral presentation at the Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons, Dallas, Texas, USA, 28th April 2006     

Large bowel obstruction due to colorectal carcinoma can be safely treated by colonic stent insertion – case series from a UK district general hospital

Aim The aim of this study is to audit our outcomes and experience of colonic stent insertion for malignant bowel obstruction. Method Retrospective audit of all stent insertions in a single district general hospital between August 2003 and December 2009. All patients had presented with acute bowel obstruction caused by malignant colorectal disease and details were collected prospectively and contemporaneously onto a database. Stent insertion was a combined endoscopic and fluoroscopic procedure involving a colorectal surgeon and consultant radiologist. Results Stenting was attempted on 62 occasions in 54 patients. The technical success rate was 86% and the clinical success rate 84%. The indications for stenting were for relief of acute bowel obstruction, palliation and as a bridge to surgery. There were complications in 14 cases (22.5%) including three perforations and one perioperative mortality. There were three cases of stent migration, six cases of re‐stenosis and two stents became impacted with stool. There were no incidents of acute or delayed haemorrhage in any patients. Conclusion Our experience shows that stenting for obstructing colorectal cancer is a safe and effective method of alleviating acute and impending bowel obstruction and can be provided safely and effectively in a district general hospital.     

Endoscopic treatment of acute colorectal obstruction with self-expandable metallic stents

Background The purpose of this study was to evaluate the efficacy and security of treatment with self-expandable metallic stents for acute colonic obstruction. Methods Retrospectively, we analyzed our experience in placing colonic stents in patients with acute colonic obstruction. Sixty-two patients with malignant colon obstruction were sent to our hospital endoscopic unit from February 1999 through September 2003. The mean age was 75.21 years. A total of 63 self-expandable metallic stents were implanted. All procedures were done under endoscopic and fluoroscopic guidance. Results Technical success was obtained in 58 patients (93.54%). Clinical improvement and resolution of the obstruction were confirmed in 56 of these 58 patients (96.55%) within 48–72 h. Sixteen complications were observed in 11 patients (19%). Twelve cases were minor complications: five patients had pain and rectal tenesmus, and there were seven cases of distal migration of the stent. Four patients (6.9%) had severe complications. Three patients underwent surgery to resolve colonic perforations and one patient developed a colovesical fistula 7 months after stent placement. The stent was used as a bridge to the elective surgery in 22 patients (37.93%). The mean time between stent placement and surgery was 7.66 days (range, 2–20). The stent was used as a definitive palliative treatment in 36 patients (62.07%). Conclusion Stenting was a useful treatment of acute malignant colonic obstruction. The use of stents as a “bridge to the elective surgery” allowed the intestinal preparation, general status restoration, and a one-stage operation with resection and primary reanastomosis. We have also used the stents as a definitive palliative treatment, avoiding surgery in those patients with a very widely metastatic disease or who cannot undergo operation because of comorbid underlying conditions.     

Self-expandable metallic stent for palliative treatment of colorectal malignant obstructions: risk of perforation

OBJECTIVE: The self-expandable metallic stents are a good alternative to surgery for the palliative treatment of malignant colonic obstructions. The aim of this paper was to emphasize the causes which could increase the risk of perforation. PATIENTS AND METHODS: From November 2000 to November 2001, 6 patients with malignant colonic obstruction, to whom surgery was denied due to tumor extension and/or poor general condition, have had a palliative treatment (N = 5) or an attempt (N = 1) with self-expandable metallic stents placed by endoscopy. RESULTS: Only one patient did not developed any complication and died 5 months later of cancer. Five out of the 6 patients (83%) developed a colonic perforation following stenting (N = 4) or the attempt to place the stent (N = 1), two into the first 24 h after the procedure, and three 3, 5, and 10 months later. Subsequent colostomy was done in 2 patients while the 3 others have had an external drainage of the perforation and died postoperatively. CONCLUSION: The self-expandable metallic stents seems to be a less aggressive alternative therapy to surgery for malignant colonic obstructions. Nevertheless, the high rate of colonic perforations, suggests reconsidering the indications in the definitive palliation of malignant colonic obstructions.     

Management of acute malignant large-bowel obstruction with self-expanding metal stent

Background Colorectal stents are being used for palliation and as a “bridge to surgery” in obstructing colorectal carcinoma. The purpose of this study was to review our experience with self-expanding metal stents (SEMS) as the initial interventional approach in the management of acute malignant large bowel obstruction. Methods Between February 2002 and May 2006, 67 patients underwent the insertion of a SEMS for an obstructing malignant lesion of the left-sided colon or rectum. Results In 55 patients, the stents were placed for palliation, whereas in 12 they were placed as a bridge to surgery. Stent placement was technically successful in 92.5% (n = 62), with a clinical success rate of 88% (n = 59). Two perforations that occurred during stent placement we retreated by an emergency Hartmann operation. In intention-to-treat by stent, the peri-interventional mortality was 6% (4/67). Stent migration was reported in 3 cases (5%), and stent obstruction occurred in 8 cases (13.5%). Of the nine patients with stents successfully placed as a bridge to surgery, all underwent elective single-stage operations with no death or anastomotic complication. Conclusions Stent insertion provided an effective outcome in patients with malignant colonic obstruction as a palliative and preoperative therapy.     

Colonic stenting: When and how

Since the first report in 1990 by Dohomoto et al., endoluminal stenting of the colorectum has become a viable alternative to surgery. For patients with unresectable disease, stent implantation can be considered, avoiding the need for colostomy and has been associated with a better quality of life. The long-term outcomes of palliative stenting has shown favorable results. Emergency surgery in patients with colonic obstruction is associated with significant morbidity and mortality rates. Stenting as bridge to surgery is now an alternative to emergency surgery despite the uncertainity of its long-term oncologic safety. Colonic stenting has been used in benign colonic obstructions but the data on long-term outcomes remains limited. The appropriate decision for stent or surgery in the setting of acute colonic obstruction requires a structured approach.     

How to decide on stent insertion or surgery in colorectal obstruction?

Colorectal cancer is one of the most common cancers in western society and malignant obstruction of the colon accounts for 8%-29% of all large bowel obstructions. Conventional treatment of these patients with malignant obstruction requiring urgent surgery is associated with a greater physiological insult on already nutritionally replete patients. Of late the utility of colonic stents has offered an option in the management of these patients in both the palliative and bridge to surgery setting. This has been the subject of many reviews which highlight its efficacy, particulary in reducing ostomy rates, allowing quicker return to oral diet, minimising extended post-operative recovery as well as some quality of life benefits. The uncertainity in managing patients with malignant colonic obstructions has lead to a more cautious use of stenting technology as community equipoise exists. Decision making analysis has demonstrated that surgeons' favored the use of stents in the palliative setting preferentially when compared to the curative setting where surgery was preferred. We aim to review the literature regarding the use of stent or surgery in colorectal obstruction, and then provide a discourse with regards to the approach in synthesising the data and applying it when deciding the appropriate application of stent or surgery in colorectal obstruction.     

Palliative stent implantation in the treatment of malignant colorectal obstruction

BACKGROUND: Palliative surgical interventions for the management of colonic obstruction in cases of metastasized or locally irresectable colorectal carcinoma show remarkable morbidity and mortality rates for mostly older and multimorbid patients. For manifest obstruction, placement of a self-expanding metal stent (SEMS) is considered to be a suitable minimally invasive therapeutic option. This study aimed to investigate the efficacy of stent-based treatment for malignant large bowel obstruction. METHODS: From January 1999 to June 2005, consecutive patients who had undergone placement of a SEMS for malignant colorectal obstruction were enrolled and monitored. Manifest incontinence and rectum carcinoma within 5 cm above the anocutaneous line were contraindications for SEMS implantation. For all further locations of tumor-induced stenosis, a stent was implanted using endoscopy and fluoroscopy. This case series was characterized in terms of age, carcinoma localization, complications, morbidity and mortality, and the necessity for further interventions. RESULTS: For 44 of 48 patients (92%), stents were placed successfully and obstruction was abolished. The four remaining patients experienced stent dislocation. The median of age of the patients was 77.7 years (range, 47-96 years). The distribution of malignant stenoses was as follows: rectum (n = 16, 33.3%), sigmoideal colon (n = 21, 43.8%), descending colon (n = 4, 8.3%), splenic flexure (n = 2, 4.2%), transversal colon (n = 3, 6.2%), hepatic flexure (n = 1, 2.1%), and ascending colon (n = 1, 2.1%). There was no peri-interventional morbidity or mortality. The median in situ time for the stents was 251 days (mean, 422 days), with 13 of 44 patients treated with palliative therapy showing complications (29.5%). Six patients were treated endoscopically, and three individuals underwent surgical intervention. For four patients, no further intervention was required. Overall, there was no treatment-related mortality. CONCLUSIONS: For palliative treatment of malignancy-induced colorectal obstruction, SEMS is an efficient tool associated with low morbidity and minimal mortality. From a technical point of view, all tumor locations are accessible.     

Colostomy vs self-expanding metallic stents: comparison of the two techniques in acute tumoral left colonic obstruction

Self-expanding metallic stents is an alternative treatment to colostomy that is the treatment of choice in acute tumoral left colonic obstruction. AIM OF THE STUDY: To compare morbidity, mortality, length of hospital stay and treatment performed after desobstruction using the two methods. PATIENTS AND METHODS: Thirty-three patients admitted for acute obstruction of the left colon were retrospectively separated in two groups depending on the type of intervention performed to treat the obstruction ("colostomy" group: 17 patients and "self-expanding stent group": 16 patients). We studied complications after desobstruction, hospital courses and surgical strategy performed after the acute phase. RESULTS: Time between desobstruction and colectomy was shorter in the "self-expanding stent group" than in the "colostomy group" (18.5 days versus 73 days). Age superior than 75 years and colostomy were the two main factors predicting the risk of definitive colostomy (P < 0.05). Global mean hospital stay was longer in the colostomy group (32.7 days versus 19.3 days, P = 0.02). Two perforations and one local recurrence occurred in the "self-expanding stent group". CONCLUSIONS: Self-expanding metallic stent can decrease the permanent colostomy rate and the number of interventions. The recurrence rate seems to be theoretically increased with the stenting method. Then, colostomy must be done for patients in curative situation. The self-expanding metallic stent should be used as a palliative care.     

Safety and efficacy of metallic stents in the management of colorectal obstruction.

BACKGROUND: The use of self-expandable metallic stents in the management of obstructing colorectal cancer has been described with increasing frequency in the literature. Our goal was to evaluate the efficacy and associated morbidity of the use of self-expandable metallic stents to relieve colorectal obstruction at our institution. METHODS: A retrospective chart review of patients who underwent colorectal stent placement between December 2001 and December 2003 in a tertiary referral center was performed. RESULTS: Stents were placed successfully in 17 of 21 patients (81%) with colorectal obstruction. Placement was achieved endoscopically in 13 patients and radiologically in 4. Ten self-expandable metallic stents were used as a bridge to surgery, and 7 were used for palliation. The obstructions were located in the sigmoid colon (11 patients), the rectosigmoid (3), the splenic flexure, the hepatic flexure, and the rectum. Malignant obstruction was noted in 14 patients. One patient with malignancy experienced a sigmoid perforation, and 2 patients with benign disease had complications (1 stent migration and 1 re-obstruction). Stent patency in obstruction secondary to colonic adenocarcinoma was 100% in our follow-up period (range, 5 to 15 months). CONCLUSIONS: The use of stents as a bridge to surgery is associated with low morbidity, allows for bowel preparation, and thus avoids the need for a temporary colostomy. Long-term patency suggests that stents may allow for the avoidance of an operation in patients with metastatic disease and further defines their role in the palliation of malignant obstruction. Further prospective randomized studies are necessary to fully elucidate the use of stents in the management of colorectal cancer.