Clin Endosc.  2014 Jan;47(1):65-73.

Status and Literature Review of Self-Expandable Metallic Stents for Malignant Colorectal Obstruction

Affiliations
  • 1Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 2Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea. chhyang@dongguk.ac.kr

Abstract

Use of colorectal stents has increased dramatically over the last decades. Colorectal stents offer an alternative way to relieve fatal intestinal obstruction and can take place of emergency surgery, which associated with significant morbidity and mortality and a high incidence of stoma creation, to elective resection. Although there remain a few concerns regarding the use of stents as a bridge to surgical resection, use of self-expandable metallic stents for palliation in patients with unresectable disease has come to be generally accepted. Advantages of colorectal stents include acute restoration of luminal patency and allowance of time for proper staging and surgical optimization, and the well-known disadvantages are procedure-related complications including perforation, migration, and stent failure. General indications, procedures, and clinical outcomes as well as recent evidences regarding the use of colorectal stents will be discussed in this review.

Keyword

Colorectal neoplasms; Obstruction; Self-expanding metallic stents

MeSH Terms

Colorectal Neoplasms
Emergencies
Humans
Incidence
Intestinal Obstruction
Mortality
Phenobarbital
Stents*
Phenobarbital

Reference

1. Phillips RK, Hittinger R, Fry JS, Fielding LP. Malignant large bowel obstruction. Br J Surg. 1985; 72:296–302. PMID: 3986481.
Article
2. Umpleby HC, Williamson RC. Survival in acute obstructing colorectal carcinoma. Dis Colon Rectum. 1984; 27:299–304. PMID: 6714046.
Article
3. Mella J, Biffin A, Radcliffe AG, Stamatakis JD, Steele RJ. Population-based audit of colorectal cancer management in two UK health regions. Colorectal Cancer Working Group, Royal College of Surgeons of England Clinical Epidemiology and Audit Unit. Br J Surg. 1997; 84:1731–1736. PMID: 9448628.
4. Serpell JW, McDermott FT, Katrivessis H, Hughes ES. Obstructing carcinomas of the colon. Br J Surg. 1989; 76:965–969. PMID: 2804601.
Article
5. Kim JS, Hur H, Min BS, Sohn SK, Cho CH, Kim NK. Oncologic outcomes of self-expanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructing elective surgery. World J Surg. 2009; 33:1281–1286. PMID: 19363580.
Article
6. Trompetas V. Emergency management of malignant acute left-sided colonic obstruction. Ann R Coll Surg Engl. 2008; 90:181–186. PMID: 18430330.
Article
7. Loizou LA, Grigg D, Boulos PB, Bown SG. Endoscopic Nd:YAG laser treatment of rectosigmoid cancer. Gut. 1990; 31:812–816. PMID: 1695161.
Article
8. Gevers AM, Macken E, Hiele M, Rutgeerts P. Endoscopic laser therapy for palliation of patients with distal colorectal carcinoma: analysis of factors influencing long-term outcome. Gastrointest Endosc. 2000; 51:580–585. PMID: 10805846.
Article
9. Lelcuk S, Ratan J, Klausner JM, Skornick Y, Merhav A, Rozin RR. Endoscopic decompression of acute colonic obstruction. Avoiding staged surgery. Ann Surg. 1986; 203:292–294. PMID: 3954481.
10. Dohmoto M, Rupp KD, Hohlbach G. Endoscopically-implanted prosthesis in rectal carcinoma. Dtsch Med Wochenschr. 1990; 115:915. PMID: 2354663.
11. Tejero E, Mainar A, Fernández L, Tobío R, De Gregorio MA. New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum. 1994; 37:1158–1159. PMID: 7956588.
Article
12. Rey JF, Romanczyk T, Greff M. Metal stents for palliation of rectal carcinoma: a preliminary report on 12 patients. Endoscopy. 1995; 27:501–504. PMID: 8565889.
Article
13. Fan YB, Cheng YS, Chen NW, et al. Clinical application of self-expanding metallic stent in the management of acute left-sided colorectal malignant obstruction. World J Gastroenterol. 2006; 12:755–759. PMID: 16521189.
Article
14. Xinopoulos D, Dimitroulopoulos D, Theodosopoulos T, et al. Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis. Surg Endosc. 2004; 18:421–426. PMID: 14735348.
15. Camúñez F, Echenagusia A, Simó G, Turégano F, Vázquez J, Barreiro-Meiro I. Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation. Radiology. 2000; 216:492–497. PMID: 10924576.
Article
16. Roeland E, von Gunten CF. Current concepts in malignant bowel obstruction management. Curr Oncol Rep. 2009; 11:298–303. PMID: 19508835.
Article
17. Dronamraju SS, Ramamurthy S, Kelly SB, Hayat M. Role of self-expanding metallic stents in the management of malignant obstruction of the proximal colon. Dis Colon Rectum. 2009; 52:1657–1661. PMID: 19690497.
Article
18. Dastur JK, Forshaw MJ, Modarai B, Solkar MM, Raymond T, Parker MC. Comparison of short-and long-term outcomes following either insertion of self-expanding metallic stents or emergency surgery in malignant large bowel obstruction. Tech Coloproctol. 2008; 12:51–55. PMID: 18512013.
Article
19. Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg. 2007; 246:24–30. PMID: 17592286.
20. Zorcolo L, Covotta L, Carlomagno N, Bartolo DC. Safety of primary anastomosis in emergency colo-rectal surgery. Colorectal Dis. 2003; 5:262–269. PMID: 12780890.
Article
21. Villar JM, Martinez AP, Villegas MT, et al. Surgical options for malignant left-sided colonic obstruction. Surg Today. 2005; 35:275–281. PMID: 15815842.
Article
22. Biondo S, Parés D, Frago R, et al. Large bowel obstruction: predictive factors for postoperative mortality. Dis Colon Rectum. 2004; 47:1889–1897. PMID: 15622582.
Article
23. Hsu TC. Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon. Am J Surg. 2005; 189:384–387. PMID: 15820447.
Article
24. Zorcolo L, Covotta L, Carlomagno N, Bartolo DC. Toward lowering morbidity, mortality, and stoma formation in emergency colorectal surgery: the role of specialization. Dis Colon Rectum. 2003; 46:1461–1467. PMID: 14605562.
Article
25. Breitenstein S, Rickenbacher A, Berdajs D, Puhan M, Clavien PA, Demartines N. Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction. Br J Surg. 2007; 94:1451–1460. PMID: 17968980.
Article
26. van Hooft JE, Bemelman WA, Oldenburg B, et al. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol. 2011; 12:344–352. PMID: 21398178.
Article
27. 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; 25:1814–1821. PMID: 21170659.
Article
28. 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; 99:2051–2057. PMID: 15447772.
Article
29. Baron TH. Colonic stenting: technique, technology, and outcomes for malignant and benign disease. Gastrointest Endosc Clin N Am. 2005; 15:757–771. PMID: 16278137.
Article
30. 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; 35:1904–1910. PMID: 21559998.
Article
31. Sagar J. Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev. 2011; 11:CD007378. PMID: 22071835.
Article
32. Keswani RN, Azar RR, Edmundowicz SA, 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):675–680. PMID: 19251009.
Article
33. Trompetas V, Saunders M, Gossage J, Anderson H. Shortcomings in colonic stenting to palliate large bowel obstruction from extracolonic malignancies. Int J Colorectal Dis. 2010; 25:851–854. PMID: 20390286.
Article
34. Shin SJ, Kim TI, Kim BC, Lee YC, Song SY, Kim WH. Clinical application of self-expandable metallic stent for treatment of colorectal obstruction caused by extrinsic invasive tumors. Dis Colon Rectum. 2008; 51:578–583. PMID: 18259816.
35. Tack J, Gevers AM, Rutgeerts P. Self-expandable metallic stents in the palliation of rectosigmoidal carcinoma: a follow-up study. Gastrointest Endosc. 1998; 48:267–271. PMID: 9744602.
Article
36. Cha EY, Park SH, Lee SS, et al. CT colonography after metallic stent placement for acute malignant colonic obstruction. Radiology. 2010; 254:774–782. PMID: 20177092.
Article
37. Bielawska B, Hookey LC, Jalink D. Large-diameter self-expanding metal stents appear to be safe and effective for malignant colonic obstruction with and without concurrent use of chemotherapy. Surg Endosc. 2010; 24:2814–2821. PMID: 20422432.
Article
38. Park S, Cheon JH, Park JJ, et al. Comparison of efficacies between stents for malignant colorectal obstruction: a randomized, prospective study. Gastrointest Endosc. 2010; 72:304–310. PMID: 20561619.
Article
39. Lee KM, Shin SJ, Hwang JC, et al. Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction. Gastrointest Endosc. 2007; 66:931–936. PMID: 17767930.
Article
40. 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; 71:560–572. PMID: 20189515.
Article
41. Tanaka A, Sadahiro S, Yasuda M, et al. Endoscopic balloon dilation for obstructive colorectal cancer: a basic study on morphologic and pathologic features associated with perforation. Gastrointest Endosc. 2010; 71:799–805. PMID: 20363422.
Article
42. Fiori E, Lamazza A, De Cesare A, et al. Palliative management of malignant rectosigmoidal obstruction. Colostomy vs. endoscopic stenting. A randomized prospective trial. Anticancer Res. 2004; 24:265–268. PMID: 15015606.
43. van Hooft JE, Fockens P, Marinelli AW, et al. Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy. 2008; 40:184–191. PMID: 18322873.
Article
44. Repici A, De Caro G, Luigiano C, et al. WallFlex colonic stent placement for management of malignant colonic obstruction: a prospective study at two centers. Gastrointest Endosc. 2008; 67:77–84. PMID: 18155427.
Article
45. Brehant O, Fuks D, Bartoli E, Yzet T, Verhaeghe P, Regimbeau JM. Elective (planned) colectomy in patients with colorectal obstruction after placement of a self-expanding metallic stent as a bridge to surgery: the results of a prospective study. Colorectal Dis. 2009; 11:178–183. PMID: 18477021.
Article
46. Cheung DY, Kim JY, Hong SP, et al. Outcome and safety of self-expandable metallic stents for malignant colon obstruction: a Korean multicenter randomized prospective study. Surg Endosc. 2012; 26:3106–3113. PMID: 22609981.
Article
47. Jung MK, Park SY, Jeon SW, et al. Factors associated with the long-term outcome of a self-expandable colon stent used for palliation of malignant colorectal obstruction. Surg Endosc. 2010; 24:525–530. PMID: 19597776.
Article
48. Vemulapalli R, Lara LF, Sreenarasimhaiah J, Harford WV, Siddiqui AA. A comparison of palliative stenting or emergent surgery for obstructing incurable colon cancer. Dig Dis Sci. 2010; 55:1732–1737. PMID: 19693667.
Article
49. 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; 23:789–794. PMID: 18443807.
Article
50. Faragher IG, Chaitowitz IM, Stupart DA. Long-term results of palliative stenting or surgery for incurable obstructing colon cancer. Colorectal Dis. 2008; 10:668–672. PMID: 18266885.
Article
51. 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. Surg Endosc. 2011; 25:2203–2209. PMID: 21293882.
Article
52. Nagula S, Ishill N, Nash C, et al. Quality of life and symptom control after stent placement or surgical palliation of malignant colorectal obstruction. J Am Coll Surg. 2010; 210:45–53. PMID: 20123331.
Article
53. Tekkis PP, Kinsman R, Thompson MR, Stamatakis JD. Association of Coloproctology of Great Britain, Ireland. The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg. 2004; 240:76–81. PMID: 15213621.
Article
54. Martinez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Deballón P, Moreno-Azcoita M. Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum. 2002; 45:401–406. PMID: 12068202.
55. Morino M, Bertello A, Garbarini A, Rozzio G, Repici A. Malignant colonic obstruction managed by endoscopic stent decompression followed by laparoscopic resections. Surg Endosc. 2002; 16:1483–1487. PMID: 11988801.
Article
56. Olmi S, Scaini A, Cesana G, Dinelli M, Lomazzi A, Croce E. Acute colonic obstruction: endoscopic stenting and laparoscopic resection. Surg Endosc. 2007; 21:2100–2104. PMID: 17479321.
Article
57. Stipa F, Pigazzi A, Bascone B, et al. Management of obstructive colorectal cancer with endoscopic stenting followed by single-stage surgery: open or laparoscopic resection? Surg Endosc. 2008; 22:1477–1481. PMID: 18027039.
Article
58. 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; 144:1127–1132. PMID: 20026830.
59. Maruthachalam K, Lash GE, Shenton BK, Horgan AF. Tumour cell dissemination following endoscopic stent insertion. Br J Surg. 2007; 94:1151–1154. PMID: 17541987.
Article
60. Singh H, Latosinsky S, Spiegel BM, 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; 20:779–785. PMID: 17171197.
Article
61. 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; 60:865–874. PMID: 15604999.
Article
62. Osman , Rashid , Sathananthan , Parker . The cost effectiveness of self-expanding metal stents in the management of malignant left-sided large bowel obstruction. Colorectal Dis. 2000; 2:233–237. PMID: 23578083.
Article
63. Binkert CA, Ledermann H, Jost R, Saurenmann P, Decurtins M, Zollikofer CL. Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents: a preliminary report. Radiology. 1998; 206:199–204. PMID: 9423673.
64. Khot UP, Lang AW, Murali K, Parker MC. Systematic review of the efficacy and safety of colorectal stents. Br J Surg. 2002; 89:1096–1102. PMID: 12190673.
Article
65. Repici A, Fregonese D, Costamagna G, et al. Ultraflex precision colonic stent placement for palliation of malignant colonic obstruction: a prospective multicenter study. Gastrointest Endosc. 2007; 66:920–927. PMID: 17904133.
Article
66. Suh JP, Kim SW, Cho YK, et al. Effectiveness of stent placement for palliative treatment in malignant colorectal obstruction and predictive factors for stent occlusion. Surg Endosc. 2010; 24:400–406. PMID: 19551432.
Article
67. Lee HJ, Hong SP, Cheon JH, et al. Long-term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers: endoscopic stenting versus surgery. Gastrointest Endosc. 2011; 73:535–542. PMID: 21257165.
Article
68. Meisner S, González-Huix F, Vandervoort JG, et al. 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; 74:876–884. PMID: 21855868.
Article
69. Datye A, Hersh J. Colonic perforation after stent placement for malignant colorectal obstruction: causes and contributing factors. Minim Invasive Ther Allied Technol. 2011; 20:133–140. PMID: 20929424.
70. Cennamo V, Fuccio L, Mutri V, et al. Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy? Clin Gastroenterol Hepatol. 2009; 7:1174–1176. PMID: 19631290.
Article
71. Hapani S, Chu D, Wu S. Risk of gastrointestinal perforation in patients with cancer treated with bevacizumab: a meta-analysis. Lancet Oncol. 2009; 10:559–568. PMID: 19482548.
Article
72. 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; 74:858–868. PMID: 21862005.
Article
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