Colonic Stenting

  • Ioana SmithEmail author
  • Michel Kahaleh


Colorectal stenting has been reported as an effective method of relieving colonic obstruction in the palliative setting for advanced cancer and in the preoperative setting as a bridge to surgery. Stenting can allow for an emergency operation to be converted to an elective operation. By decompressing the colon and allowing for medical optimization of the patient, self-expandable metal stent (SEMS) placement can transition a patient from a high-risk situation to a one-stage elective operation with potential primary resection and anastomosis. Stenting of select benign strictures is also accepted. In the hands of experienced advanced endoscopists, the placement of the stent has a high chance of technical and clinical success. In this chapter, we will discuss the indications and contraindications for stenting, types of stents available with advantages and disadvantages, up-to-date literature on success rates, short- and long-term complication rates, and cost. Finally, we will discuss what we feel are technical pearls for successful stenting.


Colonic stent Self-expandable stent Colon cancer Colon obstruction Colon stenosis Endoscopic Palliation Enteral stent 

Supplementary material

Video 6.1 Stenting of a malignant rectosigmoid stricture: The endoscope was advanced up to the malignant rectosigmoid stricture. Under endoscopic and fluoroscopic visualization, a ball tip catheter preloaded with a hydrophilic guidewire was used to cross the stricture. The ball tip was then exchanged over the wire for a 15-mm balloon catheter. The balloon catheter was advanced over the wire across the stricture and inflated; injection of contrast confirmed proximal dilation and allowed measurement of the stricture length. Over the guidewire, a 25 × 60-mm uncovered self-expanding metal stent was deployed across the stricture with good decompression (MP4 6286 kb)


  1. 1.
    Deans GT, Krukowski ZH, Irwin ST. Malignant obstructions of the left colon. Br J Surg. 1994;81:1270–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Bonin EA, Baron TH. Update on the indications and use of colonic stents. Curr Gastroenterol Rep. 2010;12:374–82.PubMedCrossRefGoogle Scholar
  3. 3.
    Finan PJ, Campbell S, Verma R, MacFie J, Gatt M, Parker MC, et al. The management of malignant large bowel obstruction: ACPGBI position statement. Colorectal Dis. 2007;9 Suppl 4:1–17.PubMedCrossRefGoogle Scholar
  4. 4.
    Tan CJ, Dasari BVM, Gardiner K. Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction. Br J Surg. 2012;99:469–76.PubMedCrossRefGoogle Scholar
  5. 5.
    Wong R, Rappaport W, Witze D, et al. Factors influencing the safety of colostomy closure in the elderly. J Surg Res. 1994;57:289–92.PubMedCrossRefGoogle Scholar
  6. 6.
    Farrell JJ. Preoperative colonic stenting: how, when, and why? Curr Opin Gastroenterol. 2007;23(05):544–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Beck DE. Endoscopic colonic stents and dilation. Clin Colon Rectal Surg. 2010;23(1):37–41.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Baron TH, Song LMW, Repici A. Role of self-expandable stents for patients with colon cancer (with videos). Gastrointest Endosc. 2012;75(3):653–62.PubMedCrossRefGoogle Scholar
  9. 9.
    Baron TH. Acute colonic obstruction. Gastrointest Endosc Clin N Am. 2007;17(2):323–39.PubMedCrossRefGoogle Scholar
  10. 10.
    Baron TH. Colonic stenting: a palliative measure only or a bridge to surgery? Endoscopy. 2010;42:163–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Repici A, Adler DG, Gibbs CM, Malesci A, Preatoni P, et al. Stenting of the proximal colon in patients with malignant large bowel obstruction: techniques and outcomes. Gastrointest Endosc. 2007;66(5):940–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Tal AO, Friedrich-Rust M, Bechstein WO, Woeste G, Trojan J, Zeuzem S, et al. Self-expandable metal stent for malignant colonic obstruction: outcome in proximal vs. left sided tumor localization. Z Gastroenterol. 2013;51(6):551–7.PubMedCrossRefGoogle Scholar
  13. 13.
    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):478–88.PubMedCrossRefGoogle Scholar
  14. 14.
    Van Hooft JE, et al. Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy. 2008;40(3): 184–91.PubMedCrossRefGoogle Scholar
  15. 15.
    Choi JH, Lee YJ, Kim ES, Choi JH, Cho KB, Park KS, et al. Covered self-expandable metal stents are more associated with complications in the management of malignant colorectal obstruction. Surg Endosc. 2013;27:3220–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Lee KM. Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction. Gastrointest Endosc. 2007;66(5):931–6.PubMedCrossRefGoogle Scholar
  17. 17.
    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):2051–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Rodrigues C, Oliveira A, Santos L, Pires E, Deus J. Biodegradable stent for the treatment of a colonic stricture in crohn’s disease. World J Gastrointest Endosc. 2013;5(5):265–9.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Sagar J. Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev. 2011;(11):CD007378.Google Scholar
  20. 20.
    Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ, et al. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg. 2007;246(1):24–30.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Meisner S, Gonzalez-Huix F, Vandervoort JG, Repici A, Xinopoulos D, et al. Self-expanding metal stenting for palliation of patients with malignant colonic obstruction: effectiveness and efficacy on 255 patients with 12-month’s follow-up. Gastroenterol Res Pract. 2012;2012:1–6.CrossRefGoogle Scholar
  22. 22.
    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):931–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Tilney HS, Lovegrove RE, Purkayastha S, Sains PS, Weston-Petrides GK, et al. Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc. 2007;21(2):225–33.PubMedCrossRefGoogle Scholar
  24. 24.
    Baron TH, Dean PA, Yates 3rd MR, Canon C, Koehler RE. Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc. 1998;47: 277–86.PubMedCrossRefGoogle Scholar
  25. 25.
    Suzuki N, Saunders BP, Thomas-Gibson S, Akle C, Marshall M, et al. Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Dis Colon Rectum. 2004;47(7):1201–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Vanbiervliet G, Bichard P, Demarquay JF, Ben-Soussan E, Lecleire S, et al. Fully-covered self-expanding metal stents for benign colonic strictures. Endoscopy. 2013;45(1):35–41.PubMedGoogle Scholar
  27. 27.
    Small AJ, Young-Fadok TM, Baron TH. Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases. Surg Endosc. 2008;22(2):454–62.PubMedCrossRefGoogle Scholar
  28. 28.
    Kim JY, Kim SG, Im JP, Kim JS, Jung HC, et al. Comparison of treatment outcomes of endoscopic stenting for colonic and extracolonic malignant obstruction. Surg Endosc. 2013;27(1):272–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Keswani RN, Azar RR, Edmundowicz SA, Zhang Q, Ammar T, et al. Stenting for malignant colonic obstruction: a comparison of efficacy and complications in colonic versus extracolonic malignancy. Gastrointest Endosc. 2009;69(3 Pt 2):675–80.PubMedCrossRefGoogle Scholar
  30. 30.
    Simmons DT, Barron TH. Technology insight: enteral stenting and new technology. Nat Clin Pract Gastroenterol Hepatol. 2005;2(8):365–74.PubMedCrossRefGoogle Scholar
  31. 31.
    Baron TH. Expandable gastrointestinal stents. Gastroenterology. 2007;133:1407–11.PubMedCrossRefGoogle Scholar
  32. 32.
    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): 215–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Repici A, De Caro G, Luigiano C, Fabbri C, Pagano N, et al. Wallflex colonic stent placement for management of malignant colonic obstruction: a prospective study at two centers. Gastrointest Endosc. 2008;67:77–84.PubMedCrossRefGoogle Scholar
  34. 34.
    Song HY, Kim JH, Shin JH, Kim HC, Yu CS, et al. A dual-design expandable colorectal stent for malignant colorectal obstruction: results of a multicenter study. Endoscopy. 2007;39:448–54.PubMedCrossRefGoogle Scholar
  35. 35.
    Baik SH, Kim NK, Cho HW, et al. Clinical outcomes of metallic stent insertion for obstructive colorectal cancer. Hepatogastroenterology. 2006;53:183–7.PubMedGoogle Scholar
  36. 36.
    Sabbagh C, Chatelain D, Trouillet N, Mauvais F, Bendjaballah S, et al. Does use of a metallic colon stent as a bridge to surgery modify the pathology data in patients with colonic obstruction? A case-matched study. Surg Endosc. 2013;27:3622–31.PubMedCrossRefGoogle Scholar
  37. 37.
    Karoui M, Charachon A, Delbaldo C, Loriau J, Laurent A, et al. Stents for palliation of obstructive metastatic colon cancer: impact on management and chemotherapy administration. Arch Surg. 2007;142(7):619–23.PubMedCrossRefGoogle Scholar
  38. 38.
    Ding XL, Li YD, Yang RM, Li FB, Zhang MQ. A temporary self-expanding metallic stent for malignant colorectal obstruction. World J Gastroenterol. 2013;19(7):1119–23.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Larssen L, Medhus AW, Korner H, Glomsaker T, Soberg T, et al. Long-term outcome of palliative treatment with self-expanding metal stents for malignant obstructions of the GI tract. Scand J Gastroenterol. 2012;47(12):1505–14.PubMedCrossRefGoogle Scholar
  40. 40.
    Targownik LE, Spiegel BM, Sack J, et al. Colonic stent vs emergency surgery for management of acute left-sided malignant colonic obstruction: a decision analysis. Gastrointest Endosc. 2004;60:865–74.PubMedCrossRefGoogle Scholar
  41. 41.
    Baque P, Chevallier P, Karimdjee Solihi F, et al. Colostomy vs self-expanding metallic stents: comparison of the two techniques in acute tumoral left colonic obstruction. Ann Chir. 2004;129:353–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Singh H, Latosinsky S, Spiegel BMR, Targownik LE. 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. 2006;20(12):779–85.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Internal Medicine ProgramUniversity of Alabama in BirminghamBirminghamUSA
  2. 2.Department of GastroenterologyWeill Cornell Medical CollegeNew YorkUSA

Personalised recommendations