Endoscopic self-expandable metallic stent (SEMS) decompression in patients with bowel obstruction due to colon carcinoma has been practiced for over two decades now, both in potentially curable cases and in metastatic cancer. Using this case series, we aim to review the literature on the subject and to present our initial experience with using this technique as a bridge to single-stage surgery, thus minimizing colostomy creation.
Since the year of 2020 our department has placed over 30 colonic stents, most of which were used for palliative purposes in geriatric patients with concomitant diseases or metastatic cancer. In fourteen cases the patients did not have metastatic lesions on computed tomography (CT) and contrast-enhanced ultrasound (CEUS) or had liver metastases that were resectable. Those patients received SEMS prior to being treated, 7 to 14 days later, using either laparoscopic surgical techniques or open surgery methods. They underwent single-stage surgery, eliminating the need for placing a temporary or permanent stoma.
We concluded that treatment with SEMS for bowel obstruction in colorectal cancer was safe and well tolerated, and acted as a bridge to surgery resulting in primary anastomosis, restoration of the intestinal passage, and low short-term morbidity.
Morgan E, Arnold M, Gini A, Lorenzoni V, Cabasag CJ, Laversanne M, et al. Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN. Gut. 2023 Feb;72(2):338-344. doi: 10.1136/gutjnl-2022-327736.
Thanikachalam K, Khan G. Colorectal Cancer and Nutrition. Nutrients. 2019 Jan 14;11(1):164. doi: 10.3390/nu11010164.
Spannenburg L, Sanchez Gonzalez M, Brooks A, Wei S, Li X, Liang X, et al. Surgical outcomes of colonic stents as a bridge to surgery versus emergency surgery for malignant colorectal obstruction: A systematic review and meta-analysis of high quality prospective and randomised controlled trials. Eur J Surg Oncol. 2020 Aug;46(8):1404-1414. doi: 10.1016/j.ejso.2020.04.052.
van Hooft JE, van Halsema EE, Vanbiervliet G, Beets-Tan RG, DeWitt JM, Donnellan F, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2014 Nov;46(11):990-1053. doi: 10.1055/s-0034-1390700.
De Ceglie A, Filiberti R, Baron TH, Ceppi M, Conio M. A meta-analysis of endoscopic stenting as bridge to surgery versus emergency surgery for left-sided colorectal cancer obstruction. Crit Rev Oncol Hematol. 2013 Nov;88(2):387-403. doi: 10.1016/j.critrevonc.2013.06.006.
Scomparin RC, Martins BC, Lenz L, Bento LH, Marques CS, Safatle-Ribeiro A, et al. Long-term survival analysis after endoscopic stenting as a bridge to surgery for malignant colorectal obstruction: comparison with emergency diverting colostomy. Clinics (Sao Paulo). 2020 Nov 11;75:e2046. doi: 10.6061/clinics/2020/e2046.
Koppe MJ, Boerman OC, Oyen WJ, Bleichrodt RP. Peritoneal carcinomatosis of colorectal origin: incidence and current treatment strategies. Ann Surg. 2006 Feb;243(2):212-22. doi: 10.1097/01.sla.0000197702.46394.16.
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 Mar;71(3):560-72. doi: 10.1016/j.gie.2009.10.012.
Sagar J. Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev. 2011 Nov 9;2011(11):CD007378. doi: 10.1002/14651858.CD007378.pub2.
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