CardioVascular and Interventional Radiology

, Volume 34, Issue 3, pp 462–473 | Cite as

Stenting of the Lower Gastrointestinal Tract: Current Status

  • Konstantinos Katsanos
  • Tarun SabharwalEmail author
  • Andreas Adam


Colon obstruction due to colorectal cancer is a major surgical emergency. Patients with acute bowel obstruction are usually poor surgical candidates with 10–20% operative mortality and 40–50% operative morbidity rates. Colorectal stenting is an image-guided, minimally invasive procedure, and typical indications include either palliation of inoperable malignant disease or temporary bowel decompression as a bridge to surgery. Colorectal stenting allows the patient to recover before definite elective surgical resection, reducing perioperative morbidity and mortality, overall hospital stay, and associated health care costs. Palliative stenting improves quality of life compared to surgery. A concise review is provided of contemporary stenting practice of the lower gastrointestinal tract, the colon in particular, and both palliative and preoperative adjuvant procedures are evaluated in terms of relevant patient oncology, insertion technique, available stent designs, technical and clinical outcomes, associated complications, and cost–benefit analysis.


Self-expanding Metal stents Colorectal Colonic Palliative Bridge to surgery 


Conflicts of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Athreya S, Moss J, Urquhart G et al (2006) Colorectal stenting for colonic obstruction: the indications, complications, effectiveness and outcome—5 year review. Eur J Radiol 60:91–94PubMedCrossRefGoogle Scholar
  2. 2.
    Dionigi G, Villa F, Rovera F et al (2007) Colonic stenting for malignant disease: review of literature. Surg Oncol 16(suppl 1):S153–S155PubMedCrossRefGoogle Scholar
  3. 3.
    Baron TH (2007) Acute colonic obstruction. Gastrointest Endosc Clin N Am 17:323–339PubMedCrossRefGoogle Scholar
  4. 4.
    Katsanos K, Ahmad F, Dourado R et al (2009) Interventional radiology in the elderly. Clin Interv Aging 4:1–15PubMedGoogle Scholar
  5. 5.
    Sabharwal T, Irani FG, Adam A (2007) Quality assurance guidelines for placement of gastroduodenal stents. Cardiovasc Intervent Radiol 30:1–5PubMedCrossRefGoogle Scholar
  6. 6.
    Sabharwal T, Morales JP, Irani FG, Adam A (2005) Quality improvement guidelines for placement of esophageal stents. Cardiovasc Intervent Radiol 28:284–288PubMedCrossRefGoogle Scholar
  7. 7.
    Simmons DT, Baron TH (2005) Technology insight: enteral stenting and new technology. Nat Clin Pract Gastroenterol Hepatol 2:365–374PubMedCrossRefGoogle Scholar
  8. 8.
    Baron TH, Harewood GC (2003) Enteral self-expandable stents. Gastrointest Endosc 58:421–433PubMedCrossRefGoogle Scholar
  9. 9.
    Zollikofer CL (2000) Stenting of upper and lower GI tract obstruction. Acta Gastroenterol Belg 63:165–168PubMedGoogle Scholar
  10. 10.
    Lowe AS, Sheridan MB (2004) Esophageal stenting. Sem Interventional Radiol 21:157–166CrossRefGoogle Scholar
  11. 11.
    Sabharwal T, Morales JP, Salter R, Adam A (2005) Esophageal cancer: self-expanding metallic stents. Abdom Imaging 30:456–464PubMedCrossRefGoogle Scholar
  12. 12.
    Watt AM, Faragher IG, Griffin TT et al (2007) Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 246:24–30PubMedCrossRefGoogle Scholar
  13. 13.
    Xinopoulos D, Dimitroulopoulos D, Theodosopoulos T et al (2004) Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis. Surg Endosc 18:421–426PubMedCrossRefGoogle Scholar
  14. 14.
    Finan PJ, Campbell S, Verma R et al (2007) The management of malignant large bowel obstruction: ACPGBI position statement. Colorectal Dis 9(suppl 4):1–17PubMedCrossRefGoogle Scholar
  15. 15.
    Baerlocher MO, Asch MR, Dixon P et al (2008) Interdisciplinary Canadian guidelines on the use of metal stents in the gastrointestinal tract for oncological indications. Can Assoc Radiol J 59:107–122PubMedGoogle Scholar
  16. 16.
    Mauro MA, Koehler RE, Baron TH (2000) Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents. Radiology 215:659–669PubMedGoogle Scholar
  17. 17.
    Small AJ, Coelho-Prabhu N, Baron TH (2010) Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc 71:560–572PubMedCrossRefGoogle Scholar
  18. 18.
    Baron TH (2009) Interventional palliative strategies for malignant bowel obstruction. Curr Oncol Rep 11:293–297PubMedCrossRefGoogle Scholar
  19. 19.
    Benson AB III (2007) Epidemiology, disease progression, and economic burden of colorectal cancer. J Manag Care Pharm 13(6 suppl C):S5–S18PubMedGoogle Scholar
  20. 20.
    Kubba AK, Krasner N (2000) An update in the palliative management of malignant dysphagia. Eur J Surg Oncol 26:116–129PubMedCrossRefGoogle Scholar
  21. 21.
    Griffith RS (1992) Preoperative evaluation. Medical obstacles to surgery. Cancer 70(5 suppl):1333–1341PubMedCrossRefGoogle Scholar
  22. 22.
    Fan YB, Cheng YS, Chen NW et al (2006) Clinical application of self-expanding metallic stent in the management of acute left-sided colorectal malignant obstruction. World J Gastroenterol 12:755–759PubMedGoogle Scholar
  23. 23.
    Sebastian S, Johnston S, Geoghegan T et al (2004) Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99:2051–2057PubMedCrossRefGoogle Scholar
  24. 24.
    Tekkis PP, Poloniecki JD, Thompson MR, Stamatakis JD (2003) Operative mortality in colorectal cancer: prospective national study. BMJ 327(7425):1196–1201PubMedCrossRefGoogle Scholar
  25. 25.
    Buechter KJ, Boustany C, Caillouette R, Cohn I Jr (1988) Surgical management of the acutely obstructed colon. A review of 127 cases. Am J Surg 156(3 pt 1):163–168PubMedCrossRefGoogle Scholar
  26. 26.
    Dharmadhikari R, Nice C (2008) Complications of colonic stenting: a pictorial review. Abdom Imaging 33:278–284PubMedCrossRefGoogle Scholar
  27. 27.
    Karadag A, Mentes BB, Uner A et al (2003) Impact of stomatherapy on quality of life in patients with permanent colostomies or ileostomies. Int J Colorectal Dis 18:234–238PubMedGoogle Scholar
  28. 28.
    Brown H, Randle J (2005) Living with a stoma: a review of the literature. J Clin Nurs 14:74–81PubMedCrossRefGoogle Scholar
  29. 29.
    Lelcuk S, Ratan J, Klausner JM et al (1986) Endoscopic decompression of acute colonic obstruction. Avoiding staged surgery. Ann Surg 203:292–294PubMedCrossRefGoogle Scholar
  30. 30.
    Dohmoto M, Hunerbein M, Schlag PM (1996) Palliative endoscopic therapy of rectal carcinoma. Eur J Cancer 32A:25–29PubMedCrossRefGoogle Scholar
  31. 31.
    Dohmoto M, Rupp KD, Hohlbach G (1990) Endoscopically-implanted prosthesis in rectal carcinoma. Dtsch Med Wochenschr 115:915PubMedGoogle Scholar
  32. 32.
    Tejero E, Mainar A, Fernandez L et al (1994) New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum 37:1158–1159PubMedCrossRefGoogle Scholar
  33. 33.
    Aitken DG, Horgan AF (2007) Endoluminal insertion of colonic stents. Surg Oncol 16:59–63PubMedCrossRefGoogle Scholar
  34. 34.
    Alcantara M, Serra X, Bombardo J et al (2007) Colorectal stenting as an effective therapy for preoperative and palliative treatment of large bowel obstruction: 9 years’ experience. Tech Coloproctol 11:316–322PubMedCrossRefGoogle Scholar
  35. 35.
    Repici A, Reggio D, De Angelis C et al (2000) Covered metal stents for management of inoperable malignant colorectal strictures. Gastrointest Endosc 52:735–740PubMedCrossRefGoogle Scholar
  36. 36.
    Baron TH (2007) Expandable gastrointestinal stents. Gastroenterology 133:1407–1411PubMedCrossRefGoogle Scholar
  37. 37.
    Malloy PC, Grassi CJ, Kundu S et al (2009) Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 20(7 suppl):S240–S249PubMedCrossRefGoogle Scholar
  38. 38.
    Arenas RB, Fichera A, Mhoon D, Michelassi F (1997) Incidence and therapeutic implications of synchronous colonic pathology in colorectal adenocarcinoma. Surgery 122:706–709PubMedCrossRefGoogle Scholar
  39. 39.
    Velling TE, Hall LD, Brennan FJ (2000) Colonic stent placement facilitated by percutaneous cecostomy and antegrade enema. AJR Am J Roentgenol 175:119–120PubMedGoogle Scholar
  40. 40.
    Gillman LM, Latosinsky S (2006) Anterograde colonic stent placement via a cecostomy tube site. Can J Gastroenterol 20:425–426PubMedGoogle Scholar
  41. 41.
    Jost RS, Jost R, Schoch E et al (2007) Colorectal stenting: an effective therapy for preoperative and palliative treatment. Cardiovasc Intervent Radiol 30:433–440PubMedCrossRefGoogle Scholar
  42. 42.
    Deans GT, Krukowski ZH, Irwin ST (1994) Malignant obstruction of the left colon. Br J Surg 81:1270–1276PubMedCrossRefGoogle Scholar
  43. 43.
    Yim HB, Jacobson BC, Saltzman JR et al (2001) Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction. Gastrointest Endosc 53:329–332PubMedGoogle Scholar
  44. 44.
    Harris GJ, Senagore AJ, Lavery IC, Fazio VW (2001) The management of neoplastic colorectal obstruction with colonic endolumenal stenting devices. Am J Surg 181:499–506PubMedCrossRefGoogle Scholar
  45. 45.
    Lopera JE, Brazzini A, Gonzales A, Castaneda-Zuniga WR (2004) Gastroduodenal stent placement: current status. Radiographics 24:1561–1573PubMedCrossRefGoogle Scholar
  46. 46.
    Zollikofer CL, Jost R, Schoch E, Decurtins M (2000) Gastrointestinal stenting. Eur Radiol 10:329–341PubMedCrossRefGoogle Scholar
  47. 47.
    Given MF, Lyon SM, Lee MJ (2004) The role of the interventional radiologist in enteral alimentation. Eur Radiol 14:38–47PubMedCrossRefGoogle Scholar
  48. 48.
    de Gregorio MA, Mainar A, Tejero E et al (1998) Acute colorectal obstruction: stent placement for palliative treatment—results of a multicenter study. Radiology 209:117–120PubMedGoogle Scholar
  49. 49.
    Vakil N, Gross U, Bethge N (1999) Human tissue responses to metal stents. Gastrointest Endosc Clin N Am 9:359–365PubMedGoogle Scholar
  50. 50.
    Siersema PD (2008) Treatment options for esophageal strictures. Nat Clin Pract Gastroenterol Hepatol 5:142–152PubMedCrossRefGoogle Scholar
  51. 51.
    Sabharwal T, Hamady MS, Chui S et al (2003) A randomised prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma. Gut 52:922–926PubMedCrossRefGoogle Scholar
  52. 52.
    Morgan R, Adam A (1999) The radiologist’s view of expandable metallic stents for malignant esophageal obstruction. Gastrointest Endosc Clin N Am 9:431–435PubMedGoogle Scholar
  53. 53.
    Bonin EA, Baron TH (2010) Update on the indications and use of colonic stents. Curr Gastroenterol Rep 12:374–382PubMedCrossRefGoogle Scholar
  54. 54.
    Shellock FG, Crues JV (2004) MR procedures: biologic effects, safety, and patient care. Radiology 232:635–652PubMedCrossRefGoogle Scholar
  55. 55.
    Nitatori T, Hanaoka H, Hachiya J, Yokoyama K (1999) MRI artifacts of metallic stents derived from imaging sequencing and the ferromagnetic nature of materials. Radiat Med 17:329–334PubMedGoogle Scholar
  56. 56.
    Taal BG, Muller SH, Boot H, Koops W (1997) Potential risks and artifacts of magnetic resonance imaging of self-expandable esophageal stents. Gastrointest Endosc 46:424–429PubMedCrossRefGoogle Scholar
  57. 57.
    Khot UP, Lang AW, Murali K, Parker MC (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89:1096–1102PubMedCrossRefGoogle Scholar
  58. 58.
    Dormann A, Meisner S, Verin N, Wenk Lang A (2004) Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 36:543–550PubMedCrossRefGoogle Scholar
  59. 59.
    Low DE, Panto PN, Hastings AG, Nigam K (2004) An unusual complication of a colonic wallstent. Cardiovasc Intervent Radiol 27:377–378PubMedCrossRefGoogle Scholar
  60. 60.
    Wholey MH, Ferral H, Reyes R et al (1997) Retrieval of migrated colonic stents from the rectum. Cardiovasc Intervent Radiol 20:477–480PubMedCrossRefGoogle Scholar
  61. 61.
    Shim CS, Cho JY, Jung IS et al (2004) Through-the-scope double colonic stenting in the management of inoperable proximal malignant colonic obstruction: a pilot study. Endoscopy 36:426–431PubMedCrossRefGoogle Scholar
  62. 62.
    Maruthachalam K, Lash GE, Shenton BK, Horgan AF (2007) Tumour cell dissemination following endoscopic stent insertion. Br J Surg 94:1151–1154PubMedCrossRefGoogle Scholar
  63. 63.
    Camunez F, Echenagusia A, Simo G et al (2000) Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation. Radiology 216:492–497PubMedGoogle Scholar
  64. 64.
    Meisner S, Hensler M, Knop FK et al (2004) Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center. Dis Colon Rectum 47:444–450PubMedCrossRefGoogle Scholar
  65. 65.
    Soto S, Lopez-Roses L, Gonzalez-Ramirez A et al (2006) Endoscopic treatment of acute colorectal obstruction with self-expandable metallic stents: experience in a community hospital. Surg Endosc 20:1072–1076PubMedCrossRefGoogle Scholar
  66. 66.
    Saida Y, Sumiyama Y, Nagao J, Uramatsu M (2003) Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 46(10 suppl):S44–S49PubMedGoogle Scholar
  67. 67.
    Ng KC, Law WL, Lee YM et al (2006) Self-expanding metallic stent as a bridge to surgery versus emergency resection for obstructing left-sided colorectal cancer: a case-matched study. J Gastrointest Surg 10:798–803PubMedCrossRefGoogle Scholar
  68. 68.
    Law WL, Choi HK, Chu KW (2003) Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg 90:1429–1433PubMedCrossRefGoogle Scholar
  69. 69.
    Johnson R, Marsh R, Corson J, Seymour K (2004) A comparison of two methods of palliation of large bowel obstruction due to irremovable colon cancer. Ann R Coll Surg Engl 86:99–103PubMedCrossRefGoogle Scholar
  70. 70.
    Govindarajan A, Naimark D, Coburn NG et al (2007) Use of colonic stents in emergent malignant left colonic obstruction: a Markov chain Monte Carlo decision analysis. Dis Colon Rectum 50:1811–1824PubMedCrossRefGoogle Scholar
  71. 71.
    Katsanos K, Sabharwal T, Koletsis E et al (2009) Direct erosion and prolapse of esophageal stents into the tracheobronchial tree leading to life-threatening airway compromise. J Vasc Interv Radiol, November 2009 (in press)Google Scholar
  72. 72.
    Garcea G, Sutton CD, Lloyd TD et al (2003) Management of benign rectal strictures: a review of present therapeutic procedures. Dis Colon Rectum 46:1451–1460PubMedCrossRefGoogle Scholar
  73. 73.
    Paul L, Pinto I, Gomez H et al (2002) Metallic stents in the treatment of benign diseases of the colon: preliminary experience in 10 cases. Radiology 223:715–722PubMedCrossRefGoogle Scholar
  74. 74.
    Suzuki N, Saunders BP, Thomas-Gibson S et al (2004) Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Dis Colon Rectum 47:1201–1207PubMedCrossRefGoogle Scholar
  75. 75.
    Keranen I, Lepisto A, Udd M et al (2010) Outcome of patients after endoluminal stent placement for benign colorectal obstruction. Scand J Gastroenterol 45:725–731PubMedCrossRefGoogle Scholar
  76. 76.
    Small AJ, Young-Fadok TM, Baron TH (2008) Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases. Surg Endosc 22:454–462PubMedCrossRefGoogle Scholar
  77. 77.
    Binkert CA, Ledermann H, Jost R et al (1998) Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents—a preliminary report. Radiology 206:199–204PubMedGoogle Scholar
  78. 78.
    Singh H, Latosinsky S, Spiegel BM, Targownik LE (2006) The cost-effectiveness of colonic stenting as a bridge to curative surgery in patients with acute left-sided malignant colonic obstruction: a Canadian perspective. Can J Gastroenterol 20:779–785PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010

Authors and Affiliations

  • Konstantinos Katsanos
    • 1
    • 2
  • Tarun Sabharwal
    • 2
    Email author
  • Andreas Adam
    • 2
  1. 1.Department of Interventional RadiologyPatras University Hospital, School of MedicinePatrasGreece
  2. 2.Department of Interventional RadiologyGuy’s and St. Thomas’ HospitalLondonUK

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