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

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Stents Large intestine Intestinal obstruction Colorectal neoplasms Systematic review 

Notes

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.

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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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