Journal of Gastrointestinal Surgery

, Volume 20, Issue 2, pp 455–462 | Cite as

Self-Expanding Metallic Stents for the Management of Emergency Malignant Large Bowel Obstruction: a Systematic Review

  • Yasoba Nayanapriya Atukorale
  • Jody Lynne Church
  • Benjamin Lee Hoggan
  • Robyn Sheree Lambert
  • Stefanie Lynette Gurgacz
  • Stephen Goodall
  • Guy J. Maddern
Review Article



This paper evaluates the safety and effectiveness of self-expanding metallic stents (SEMS) for the management of emergency malignant colorectal obstruction in patients otherwise requiring multi-stage surgery. No systematic review has been conducted comparing SEMS to only multi-stage surgery.


Bibliographic databases, including Cochrane, PubMed, EMBASE, and CINAHL, were searched in September 2011 and repeated in November 2013. A pre-determined protocol outlined the study inclusion and appraisal.


Forty articles were included, seven compared SEMS to multi-stage surgery. Included studies were of low to moderate quality. Bowel perforation was the most severe stent-related complication, while tumor- and stent-related events occurred most frequently. No significant differences in rates of obstruction relief were reported between treatments, and results regarding relative quality of life were inconclusive. SEMS recipients progressed to elective surgery sooner and required shorter post-procedural hospital stays, but commonly required re-intervention. SEMS provided enduring palliative relief of obstruction, with comparable survival longevity between treatments.


SEMS placement is a viable alternative to multi-stage surgery, providing patients with benefits as a bridge-to-surgery and relief of obstruction in a palliative context, with minimal differences in clinical success and safety compared to multi-stage surgery.


Stents Large intestine Intestinal obstruction Colorectal neoplasms Systematic review 


Compliance with Ethical Standards

Sources of Support

This paper is a précis of a systematic review commissioned by the Australian Department of Health. The Department has not developed, funded, or endorsed this manuscript.

Conflict of Interest

Authors do not have financial interests or potential conflicts of interest to declare.


  1. 1.
    Davis MP, Nouneh C. Modern management of cancer-related intestinal obstruction. Curr Pain Headache Rep. 2001; 5(3):257–264.CrossRefPubMedGoogle Scholar
  2. 2.
    Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004;99(10):2051–2057.CrossRefPubMedGoogle Scholar
  3. 3.
    Winslet M. Bailey & Love’s Short Practice of Surgery. 24 ed. London: Arnorl Publishers; 2004.Google Scholar
  4. 4.
    Dauphine CE, Tan P, Beart RW, Jr., Vukasin P, Cohen H, Corman ML. Placement of self-expanding metal stents for acute malignant large-bowel obstruction: a collective review. Annals of surgical oncology. 2002;9(6):574–579.CrossRefPubMedGoogle Scholar
  5. 5.
    Gainant A. Emergency management of acute colonic cancer obstruction. J Visc Surg. 2012;149(1):3–10.CrossRefGoogle Scholar
  6. 6.
    Park S, Cheon JH, Park JJ, Moon CM, Hong SP, Lee SK, Kim TI, Kim WH. Comparison of efficacies between stents for malignant colorectal obstruction: a randomized, prospective study. Gastrointest Endosc. 2010;72(2):304–310.CrossRefPubMedGoogle Scholar
  7. 7.
    National Institute of Clinical Excellence. Guidance on Cancer Services, Improving Outcomes in Colorectal Cancers, Manual Update [PDF on Internet]. London: National Institute of Clinical Excellence; 2004 [Accessed 12 February 2015]. Available from:
  8. 8.
    Atukorale Y, Church J, Hoggan B, Lambert R, Gurgacz S, Goodall S. Insertion of colonic stents for the treatment of malignant large bowel obstruction [PDF on Internet]. Canberra: Commonwealth of Australia; 2012 [Accessed 12 February 2015]. Available from:$File/1150-Assessment-Report-Final.pdf.
  9. 9.
    Williams D, Law R, Pullyblank AM. Colorectal stenting in malignant large bowel obstruction: the learning curve. International Journal of Surgical Oncology. 2011;917848:1–4.CrossRefGoogle Scholar
  10. 10.
    Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008]: The Cochrane Collaboration; 2008.Google Scholar
  11. 11.
    Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, Gøtzsche PC, Lang T; Consort Group (Consolidated Standards of Reporting Trials). The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001;134(8):663–694.CrossRefPubMedGoogle Scholar
  12. 12.
    National Health and Medical Research Council. NHMRC levels of evidence and grades for recommendations for developers of guidelines Canberra: National Health and Medical Research Council; 2009 [Accessed 12 February 2015].Google Scholar
  13. 13.
    Fiori E, Lamazza A, De Cesare A, Bononi M, Volpino P, Schillaci A, Cavallaro A, Cangemi V. Palliative management of malignant rectosigmoidal obstruction. Colostomy vs. endoscopic stenting. A randomized prospective trial. Anticancer Res. 2004;24(1):265–268.PubMedGoogle Scholar
  14. 14.
    Xinopoulos D, Dimitroulopoulos D, Theodosopoulos T, Tsamakidis K, Bitsakou G, Plataniotis G, Gontikakis M, Kontis M, Paraskevas I, Vassilobpoulos P, Paraskevas E. Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis. Surgical endoscopy. 2004;18(3):421–426.CrossRefPubMedGoogle Scholar
  15. 15.
    Baik SH, Kim NK, Cho HW, Lee KY, Sohn SK, Cho CH, Kim TI, Kim WH. Clinical outcomes of metallic stent insertion for obstructive colorectal cancer. Hepatogastroenterology. 2006;53(58):183–187.PubMedGoogle Scholar
  16. 16.
    Johnson R, Marsh R, Corson J, Seymour K. A comparison of two methods of palliation of large bowel obstruction due to irremovable colon cancer. Ann R Coll Surg Engl. 2004;86(2):99–103.PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Nagula S, Ishill N, Nash C, Markowitz AJ, Schattner MA, Temple L, Weiser MR, Thaler HT, Zauber A, Gerdes H. Quality of life and symptom control after stent placement or surgical palliation of malignant colorectal obstruction. J Am Coll Surg. 2010;210(1):45–53.CrossRefPubMedGoogle Scholar
  18. 18.
    Osman HS, Rashid HI, Sathananthan N, Parker MC. The cost effectiveness of self-expanding metal stents in the management of malignant left-sided large bowel obstruction. Colorectal Disease. 2000;2(4):233–237.CrossRefPubMedGoogle Scholar
  19. 19.
    Varadarajulu S, Roy A, Lopes T, Drelichman ER, Kim M. Endoscopic stenting versus surgical colostomy for the management of malignant colonic obstruction: comparison of hospital costs and clinical outcomes. Surgical endoscopy. 2011;25(7):2203–2209.PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Alcantara M, Serra X, Bombardo J, Falco J, Perandreu J, Ayguavives I, Mora L, Hernando R, Navarro S. Colorectal stenting as an effective therapy for preoperative and palliative treatment of large bowel obstruction: 9 years’ experience. Tech Coloproctol. 2007;11(4):316–322.CrossRefPubMedGoogle Scholar
  21. 21.
    Athreya S, Moss J, Urquhart G, Edwards R, Downie A, Poon FW. Colorectal stenting for colonic obstruction: the indications, complications, effectiveness and outcome—5 year review. Eur J Radiol. 2006;60(1):91–94.CrossRefPubMedGoogle Scholar
  22. 22.
    Baraza W, Lee F, Brown S, Hurlstone DP. Combination endo-radiological colorectal stenting: a prospective 5-year clinical evaluation. Colorectal Dis. 2008;10(9):901–906.PubMedGoogle Scholar
  23. 23.
    Branger F, Thibaudeau E, Mucci-Hennekinne S, Metivier-Cesbron E, Vychnevskaia K, Hamy A, Arnaud JP. Management of acute malignant large-bowel obstruction with self-expanding metal stent. Int J Colorectal Dis. 2010;25(12):1481–1485.CrossRefPubMedGoogle Scholar
  24. 24.
    Cho YK, Kim SW, Lee BI, Lee KM, Lim CH, Kim JS, Chang JH, Park JM, Lee IS, Choi MG, Choi KY, Chung IS. Clinical outcome of self-expandable metal stent placement in the management of malignant proximal colon obstruction. Gut Liver. 2011;5(2):165–170.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    de Gregorio MA, Laborda A, Tejero E, Miguelena JM, Carnevale FC, de Blas I, Gimenez M, Maynar M, D'Agostino H. Ten-year retrospective study of treatment of malignant colonic obstructions with self-expandable stents. J Vasc Interv Radiol. 2011;22(6):870–878.CrossRefPubMedGoogle Scholar
  26. 26.
    Demarquay J-F, Dumas R; Vanbiervliet G; Piche T; Hastier P; Rampal P. Twelve years of colorectal stenting: Results and follow-up in 204 patients. [French, English]. Acta Endoscopica. 2008;38(4):339–347.CrossRefGoogle Scholar
  27. 27.
    García-Cano J, González-Huix F, Juzgado D, Igea F, Pérez-Miranda M, López-Rosés L, Rodríguez A, González-Carro P, Yuguero L, Espinós J, Ducóns J, Orive V, Rodríguez S. Use of self-expanding metal stents to treat malignant colorectal obstruction in general endoscopic practice (with videos). Gastrointestinal Endoscopy. 2006;64(6):914–920.CrossRefPubMedGoogle Scholar
  28. 28.
    Jost RS, Jost R, Schoch E, Brunner B, Decurtins M, Zollikofer CL. Colorectal stenting: an effective therapy for preoperative and palliative treatment. Cardiovasc Intervent Radiol. 2007;30(3):433–440.CrossRefPubMedGoogle Scholar
  29. 29.
    Keranen I, Lepisto A, Udd M, Halttunen J, Kylanpaa L. Stenting for malignant colorectal obstruction: a single-center experience with 101 patients. Surgical endoscopy. 2011;26(2):423–430.CrossRefPubMedGoogle Scholar
  30. 30.
    Kim JH, Song HY, Li YD, Shin JH, Park JH, Yu CS, Kim JC. Dual-design expandable colorectal stent for malignant colorectal obstruction: comparison of flared ends and bent ends. AJR Am J Roentgenol. 2009;193(1):248–254.CrossRefPubMedGoogle Scholar
  31. 31.
    Kim SY, Kwon SH, Oh JH. Radiologic placement of uncovered stents for the treatment of malignant colorectal obstruction. J Vasc Interv Radiol. 2010;21(8):1244–1249.CrossRefPubMedGoogle Scholar
  32. 32.
    Lee HJ, Hong SP, Cheon JH, Kim TI, Min BS, Kim NK, Kim WH. Long-term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers: endoscopic stenting versus surgery. Gastrointest Endosc. 2011;73(3):535–542.CrossRefPubMedGoogle Scholar
  33. 33.
    Lee K, Shin S, Hwang J, Cheong JY, Yoo BM, Lee KJ, Hahm KB, Kim JH, Cho SW. Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction. Gastrointestinal Endoscopy. 2007;66(5):931–936.CrossRefPubMedGoogle Scholar
  34. 34.
    Lepsenyi M, Santen S, Syk I, Nielsen J, Nemeth A, Toth E, Thorlacius H. Self-expanding metal stents in malignant colonic obstruction: experiences from Sweden. BMC Res Notes. 2011;4(1):274.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Li YD, Cheng YS, Li MH, Fan YB, Chen NW, Wang Y, Zhao J. Management of acute malignant colorectal obstruction with a novel self-expanding metallic stent as a bridge to surgery. Eur J Radiol. 2010;73(3):566–571.CrossRefPubMedGoogle Scholar
  36. 36.
    Mackay CD, Craig W, Hussey JK, Loudon MA. Self-expanding metallic stents for large bowel obstruction. Br J Surg. 2011;98(11):1625–1629.CrossRefPubMedGoogle Scholar
  37. 37.
    Mainar A, De Gregorio Ariza MA, Tejero E, Tobio R, Alfonso E, Pinto I, Herrera M, Fernandez JA. Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery—results of a multicenter study. Radiology. 1999;210(1):65–69.CrossRefPubMedGoogle Scholar
  38. 38.
    Masci E, Viale E, Mangiavillano B, Contin G, Lomazzi A, Buffoli F, Gatti M, Repaci G, Teruzzi V, Fasoli R, Ravelli P, Testoni PA. Enteral self-expandable metal stent for malignant luminal obstruction of the upper and lower gastrointestinal tract: a prospective multicentric study. J Clin Gastroenterol. 2008;42(4):389–394.CrossRefPubMedGoogle Scholar
  39. 39.
    Meisner S, Gonzalez-Huix F, Vandervoort JG, Goldberg P, Casellas JA, Roncero O, Grund KE, Alvarez A, García-Cano J, Vázquez-Astray E, Jiménez-Pérez J; WallFlex Colonic Registry Group. Self-expandable metal stents for relieving malignant colorectal obstruction: short-term safety and efficacy within 30 days of stent procedure in 447 patients. Gastrointest Endosc. 2011;74(4):876–884.CrossRefPubMedGoogle Scholar
  40. 40.
    Moon CM, Kim TI, Lee MS, Ko BM, Kim HS, Lee KM, Byeon JS, Kim YS. Comparison of a newly designed double-layered combination covered stent and D-weave uncovered stent for decompression of obstructive colorectal cancer: a prospective multicenter study. Dis Colon Rectum. 2010;53(8):1190–1196.CrossRefPubMedGoogle Scholar
  41. 41.
    Mucci-Hennekinne S, Kervegant AG, Regenet N, Beaulieu A, Barbieux JP, Dehni N, Casa C, Arnaud JP. Management of acute malignant large-bowel obstruction with self-expanding metal stent. Surgical endoscopy. 2007;21(7):1101–1103.CrossRefPubMedGoogle Scholar
  42. 42.
    Park JK, Lee MS, Ko BM, Kim HK, Kim YJ, Choi HJ, Hong SJ, Ryu CB, Moon JH, Kim JO, Cho JY, Lee JS. Outcome of palliative self-expanding metal stent placement in malignant colorectal obstruction according to stent type and manufacturer. Surgical endoscopy. 2011;25(4):1293–1299.CrossRefPubMedGoogle Scholar
  43. 43.
    Selinger CP, Ramesh J, Martin DF. Long-term success of colonic stent insertion is influenced by indication but not by length of stent or site of obstruction. Int J Colorectal Dis. 2011;26(2):215–218.CrossRefPubMedGoogle Scholar
  44. 44.
    Shrivastava V, Tariq O, Tiam R, Nyhsen C, Marsh R. Palliation of obstructing malignant colonic lesions using self-expanding metal stents: a single-center experience. Cardiovasc Intervent Radiol. 2008;31(5):931–936.CrossRefPubMedGoogle Scholar
  45. 45.
    Small AJ, Baron TH. Comparison of Wallstent and Ultraflex stents for palliation of malignant left-sided colon obstruction: a retrospective, case-matched analysis. Gastrointest Endosc. 2008;67(3):478–488.CrossRefPubMedGoogle Scholar
  46. 46.
    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):560–572.CrossRefPubMedGoogle Scholar
  47. 47.
    Stenhouse A, Page B, Rowan A, Giles L, Macdonald A. Self expanding wall stents in malignant colorectal cancer: is complete obstruction a contraindication to stent placement? Colorectal Dis. 2009;11(8):854–858.CrossRefPubMedGoogle Scholar
  48. 48.
    Suh JP, Kim SW, Cho YK, Park JM, Lee IS, Choi MG, Chung IS, Kim HJ, Kang WK, Oh ST. Effectiveness of stent placement for palliative treatment in malignant colorectal obstruction and predictive factors for stent occlusion. Surgical endoscopy. 2010;24(2):400–406.CrossRefPubMedGoogle Scholar
  49. 49.
    Vitale MA, Villotti G, d'Alba L, Frontespezi S, Iacopini F, Iacopini G. Preoperative colonoscopy after self-expandable metallic stent placement in patients with acute neoplastic colon obstruction. Gastrointest Endosc. 2006;63(6):814–819.CrossRefPubMedGoogle Scholar
  50. 50.
    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):858–868.CrossRefPubMedGoogle Scholar
  51. 51.
    Young CJ, Suen MK, Young J, Solomon MJ. Stenting large bowel obstruction avoids a stoma: consecutive series of 100 patients. Colorectal Dis. 2011;13(10):1138–1141.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2015

Authors and Affiliations

  • Yasoba Nayanapriya Atukorale
    • 1
  • Jody Lynne Church
    • 2
  • Benjamin Lee Hoggan
    • 1
  • Robyn Sheree Lambert
    • 1
  • Stefanie Lynette Gurgacz
    • 1
  • Stephen Goodall
    • 2
  • Guy J. Maddern
    • 1
    • 3
  1. 1.Australian Safety and Efficacy Register of New Interventional Procedures—Surgical (ASERNIP-S)Royal Australasian College of SurgeonsNorth AdelaideAustralia
  2. 2.Centre for Health Economics Research and Evaluation (CHERE)University of Technology SydneyHaymarketAustralia
  3. 3.Department of SurgeryUniversity of Adelaide, The Queen Elizabeth HospitalAdelaideAustralia

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