Skip to main content
SpringerLink
Log in

Large Bowel Obstruction: When Should Colon Stenting Be Considered as First-Line Strategy?

  • Chapter
  • First Online:
The SAGES Manual of Colorectal Surgery

  • 1361 Accesses

Abstract

The role of self-expanding metal stents (SEMS) in colonic obstruction continues to evolve. Stenting has been performed by skilled endoscopists throughout the colon. First-line use of SEMS for palliation of obstructing left-sided colon cancer in the face of significant comorbidity is widely accepted. Prophylactic stenting in asymptomatic left-sided colon cancer is not recommended. SEMS in colonic stent decompression as a bridge to elective surgery (SBTS) remains somewhat controversial.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Rupp KD, Dohmoto M, Meffert R, Holzgreve A, Hohlbach G. Cancer of the rectum- palliative endoscopic treatment. Eur J Surg Oncol. 1995;21(6):644–7.

    Article  CAS  Google Scholar 

  2. Tejero E, Mainar A, Fernández L, Tobío R, De Gregorio MA. New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum. 1994;37(11):1158–9.

    Article  CAS  Google Scholar 

  3. Flor-Lorente B, Báguena G, Frasson M, García-Granero A, Cervantes A, Sanchiz V, et al. Self-expanding metallic stent as a bridge to surgery in the treatment of left colon cancer obstruction: Cost-benefit analysis and oncologic results. Cir Esp. 2017;95(3):143–51.

    Article  Google Scholar 

  4. Zhang Y, Shi J, Shi B, Song CY, Xie WF, Chen YX. Comparison of efficacy between uncovered and covered self-expanding metallic stents in malignant large bowel obstruction: a systematic review and meta-analysis. Colorectal Dis. 2012;14(7):e367–74.

    Article  CAS  Google Scholar 

  5. Yang Z, Wu Q, Wang F, Ye X, Qi X, Fan D. A systematic review and meta-analysis of randomized trials and prospective studies comparing covered and bare self-expandable metal stents for the treatment of malignant obstruction in the digestive tract. Int J Med Sci. 2013;10(7):825–35.

    Article  CAS  Google Scholar 

  6. 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):560–72.

    Article  Google Scholar 

  7. Kim BC, Han KS, Hong CW, Sohn DK, Park JW, Park SC, et al. Clinical outcomes of palliative self-expanding metallic stents in patients with malignant colorectal obstruction. J Dig Dis. 2012;13(5):258–66.

    Article  Google Scholar 

  8. Im JP, Kim SG, Kang HW, Kim JS, Jung HC, Song IS. Clinical outcomes and patency of self-expanding metal stents in patients with malignant colorectal obstruction: a prospective single center study. Int J Colorectal Dis. 2008;23(8):789–94.

    Article  Google Scholar 

  9. Baron TH, Wong Kee Song LM, Repici A. Role of self-expandable stents for patients with colon cancer (with videos). Gastrointest Endosc. 2012 Mar;75(3):653–62.

    Article  Google Scholar 

  10. ASGE Standards of Practice Committee, Fisher DA, Shergill AK, Early DS, Acosta RD, Chandrasekhara V, et al. Role of endoscopy in the staging and management of colorectal cancer. Gastrointest Endosc. 2013;78(1):8–12. Erratum in: Gastrointest Endosc. 2013;78(3):559.

    Article  Google Scholar 

  11. van Hooft JE, van Halsema EE, Vanbiervliet G, Beets-Tan RGH, DeWitt JM, Donnellan F. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Gastrointest Endosc. 2014;80(5):747–61.

    Article  Google Scholar 

  12. Ferrada P, Patel MB, Poylin V, Bruns BR, Leichtle SW, Wydo S, et al. Surgery or stenting for colonic obstruction: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2016;80(4):659–64.

    Article  Google Scholar 

  13. Pisano M, Zorcolo L, Merli C, Cimbanassi S, Poiasina E, Ceresoli M, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg. 2018;13:36.

    Article  Google Scholar 

  14. van Hooft JE, Bemelman WA, Oldenburg B, Marinelli AW, Lutke Holzik MF, Grubben MJ, et al. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol. 2011;12(4):344–52.

    Article  Google Scholar 

  15. Arezzo A, Passera R, Lo Secco G, Verra M, Bonino MA, Targarona E, et al. Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc. 2017;86(3):416–26.

    Article  Google Scholar 

  16. Cheung HY, Chung CC, Tsang WW, Wong JC, Yau KK, Li MK. Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial. Arch Surg. 2009;144(12):1127–32.

    Article  Google Scholar 

  17. Ghazal AH, El-Shazly WG, Bessa SS, El-Riwini MT, Hussein AM. Colonic endolumenal stenting devices and elective surgery versus emergency subtotal/total colectomy in the management of malignant obstructed left colon carcinoma. J Gastrointest Surg. 2013;17(6):1123–9.

    Article  Google Scholar 

  18. Alcántara M, Serra-Aracil X, Falcó J, Mora L, Bombardó J, Navarro S. Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg. 2011;35(8):1904–10.

    Article  Google Scholar 

  19. Ho KS, Quah HM, Lim JF, Tang CL, Eu KW. Endoscopic stenting and elective surgery versus emergency surgery for left-sided malignant colonic obstruction: a prospective randomized trial. Int J Colorectal Dis. 2012;27(3):355–62.

    Article  Google Scholar 

  20. Pirlet IA, Slim K, Kwiatkowski F, Michot F, Millat BL. Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc. 2011;25(6):1814–21.

    Article  Google Scholar 

  21. Arezzo A, Balague C, Targarona E, Borghi F, Giraudo G, Ghezzo L, et al. Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial). Surg Endosc. 2017;31(8):3297–305.

    Article  Google Scholar 

  22. Allievi N, Ceresoli M, Fugazzola P, Montori G, Coccolini F, Ansaloni L. Endoscopic stenting as bridge to surgery versus emergency resection for left-sided malignant colorectal obstruction: an updated meta-analysis. Int J Surg Oncol. 2017;2017:2863272.

    PubMed  PubMed Central  Google Scholar 

  23. Ribeiro IB, Bernardo WM, Martins BDC, de Moura DTH, Baba ER, Josino IR, et al. Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis. Endosc Int Open. 2018;6(5):E558–67. Erratum in: Endosc Int Open. 2018;6(5):C1.

    Article  Google Scholar 

  24. Erichsen R, Horváth-Puhó E, Jacobsen JB, Nilsson T, Baron JA, Sørensen HT. Long-term mortality and recurrence after colorectal cancer surgery with preoperative stenting: a Danish nationwide cohort study. Endoscopy. 2015;47(6):517–24.

    Article  Google Scholar 

  25. Ceresoli M, Allievi N, Coccolini F, Montori G, Fugazzola P, Pisano M, et al. Long-term oncologic outcomes of stent as a bridge to surgery versus emergency surgery in malignant left side colonic obstructions: a meta-analysis. J Gastrointest Oncol. 2017;8(5):867–76.

    Article  Google Scholar 

  26. Hill J, Kay C, Morton D, Magill L, Handley K, Gray RG. CREST Trial Collaborative Group: CREST: Randomised phase III study of stenting as a bridge to surgery in obstructing colorectal cancer-results of the UK ColoRectal Endoscopic Stenting Trial (CREST). J Clin Oncol. 2016;34(Suppl):abstr 3507.

    Article  Google Scholar 

  27. Repici A, de Paula Pessoa Ferreira D. Expandable metal stents for malignant colorectal strictures. Gastrointest Endosc Clin N Am. 2011;21(3):511–33.

    Article  Google Scholar 

  28. Manes G, de Bellis M, Fuccio L, Repici A, Masci E, Ardizzone S, et al. Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent: analysis of results and predictors of outcomes in a large multicenter series. Arch Surg. 2011;146(10):1157–62.

    Article  Google Scholar 

  29. Cennamo V, Fuccio L, Mutri V, Minardi ME, Eusebi LH, Ceroni L, et al. Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy? Clin Gastroenterol Hepatol. 2009;7(11):1174–6.

    Article  Google Scholar 

  30. 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):560–72.

    Article  Google Scholar 

  31. 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):858–68.

    Article  Google Scholar 

  32. Branger F, Thibaudeau E, Mucci-Hennekinne S, Métivier-Cesbron E, Vychnevskaia K, Hamy A, et al. Management of acute malignant large-bowel obstruction with self-expanding metal stent. Int J Colorectal Dis. 2010;25(12):1481–5.

    Article  Google Scholar 

  33. de Gregorio MA, Mainar A, Rodriguez J, Alfonso ER, Tejero E, Herrera M, et al. Colon stenting: a review. Semin Intervent Radiol. 2004;21(3):205–16.

    Article  Google Scholar 

  34. Melich G, Pai A, Balachandran B, Marecik SJ, Prasad LM, Park JJ. Endoscopic control of enterocutaneous fistula by dual intussuscepting stent technique. Surg Endosc. 2016;30(9):4150–1.

    Article  Google Scholar 

  35. Kim BC, Han KS, Hong CW, Sohn DK, Park JW, Park SC, et al. Clinical outcomes of palliative self-expanding metallic stents in patients with malignant colorectal obstruction. J Dig Dis. 2012;13(5):258–66.

    Article  Google Scholar 

  36. Lee YJ, Yoon JY, Park JJ, Park SJ, Kim JH, Youn YH, et al. Clinical outcomes and factors related to colonic perforations in patients receiving self-expandable metal stent insertion for malignant colorectal obstruction. Gastrointest Endosc. 2018;87(6):1548–57.

    Article  Google Scholar 

  37. Lee JH, Yoon JY, Park SJ, Hong SP, Kim TI, Kim WH, et al. The learning curve for colorectal stent insertion for the treatment of malignant colorectal obstruction. Gut Liver. 2012;6(3):328–33.

    Article  Google Scholar 

  38. Cui J, Zhang JL, Wang S, Sun ZQ, Jiang XL. A preliminary study of stenting followed by laparoscopic surgery for obstructing left-sided colon cancer [Article in Chinese]. Zhonghua Wei Chang Wai Ke Za Zhi. 2011;14(1):40–3.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Royal Columbian Hospital, Department of General Surgery, New Westminster, BC, Canada

    George Melich & Elena Vikis

  2. University of British Columbia, Department of General Surgery, New Westminster, BC, Canada

    George Melich & Elena Vikis

  3. Department of Surgical Sciences, University of Torino, Torino, Italy

    Alberto Arezzo

Authors
  1. George Melich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elena Vikis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alberto Arezzo
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA

    Patricia Sylla

  2. Keck School of Medicine of USC, Los Angeles, CA, USA

    Andreas M. Kaiser

  3. Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA

    Daniel Popowich

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Melich, G., Vikis, E., Arezzo, A. (2020). Large Bowel Obstruction: When Should Colon Stenting Be Considered as First-Line Strategy?. In: Sylla, P., Kaiser, A., Popowich, D. (eds) The SAGES Manual of Colorectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-24812-3_27

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-24812-3_27

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-24811-6

  • Online ISBN: 978-3-030-24812-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation