Clin Endosc.  2013 Jul;46(4):355-367.

Evidence-Based Recommendations on Colorectal Stenting: A Report from the Stent Study Group of the Korean Society of Gastrointestinal Endoscopy

Affiliations
  • 1Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea.
  • 2Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
  • 5Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  • 6Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea. chhyang@dongguk.ac.kr

Abstract

Recently, placement of self-expandable metallic stents has been used for the treatment of colorectal obstruction. As domestic awareness of colorectal cancer has increased, the number of colorectal stenting procedures performed has also increased. We aimed to provide evidence-based recommendations for colorectal stenting to aid gastroenterologists in making informed decisions regarding the management of patients who present with colorectal obstruction. The working group consisted of eight gastroenterologists who actively practice and conduct research in the field of colorectal stenting and are the members of the Stent Study Group of the Korean Society of Gastrointestinal Endoscopy. A literature search was conducted using the PubMed, Embase, KoreaMed, and the Cochrane Library databases to identify relevant articles published between January 2001 and June 2012. Based on the modified Delphi process, 10 recommendation statements regarding indications, usefulness, methodology and complications of colorectal stenting, and alternative treatments for malignant colorectal obstruction were determined. The contents will be widely distributed, and periodically revised to reflect the latest knowledge. These evidence-based recommendations for colorectal stenting will provide gastroenterologists and patients with appropriate and balanced information, and will improve the quality of care.

Keyword

Colorectal obstruction; Colorectal stenting; Recommendation; Self-expandable metallic stents

MeSH Terms

Colorectal Neoplasms
Endoscopy, Gastrointestinal
Humans
Stents

Reference

1. Barillari P, Aurello P, De Angelis R, et al. Management and survival of patients affected with obstructive colorectal cancer. Int Surg. 1992; 77:251–255. PMID: 1335999.
2. Phillips RK, Hittinger R, Fry JS, Fielding LP. Malignant large bowel obstruction. Br J Surg. 1985; 72:296–302. PMID: 3986481.
Article
3. Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg. 1994; 81:1270–1276. PMID: 7953385.
Article
4. Guyatt GH, Cook DJ, Jaeschke R, Pauker SG, Schünemann HJ. Grades of recommendation for antithrombotic agents: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008; 133(6 Suppl):123S–131S. PMID: 18574262.
5. Schunemann HJ, Oxman AD, Brozek J, et al. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ. 2008; 336:1106–1110. PMID: 18483053.
Article
6. 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.
7. Tilney HS, Lovegrove RE, Purkayastha S, et al. Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc. 2007; 21:225–233. PMID: 17160651.
Article
8. 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.
9. Sagar J. Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev. 2011; (11):CD007378. PMID: 22071835.
Article
10. Tan CJ, Dasari BV, 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; 99:469–476. PMID: 22261931.
11. van Hooft JE, Bemelman WA, Breumelhof R, et al. Colonic stenting as bridge to surgery versus emergency surgery for management of acute left-sided malignant colonic obstruction: a multicenter randomized trial (Stent-in 2 study). BMC Surg. 2007; 7:12. PMID: 17608947.
Article
12. Elsberger B, Rourke K, Brush J, Glancy S, Collie M. Self-expanding metallic stent insertion in the proximal colon. Colorectal Dis. 2008; 10:194–196. PMID: 17784867.
Article
13. Repici A, Adler DG, Gibbs CM, Malesci A, Preatoni P, Baron TH. Stenting of the proximal colon in patients with malignant large bowel obstruction: techniques and outcomes. Gastrointest Endosc. 2007; 66:940–944. PMID: 17963881.
Article
14. 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
15. Kim JS, Oh SY, Seo KU, et al. Comparison of effects of preoperative stenting for obstructing colorectal cancers according to the location of the obstructing lesion. Korean J Gastroenterol. 2009; 54:384–389. PMID: 20026893.
Article
16. de Gregorio MA, Mainar A, Tejero E, et al. Acute colorectal obstruction: stent placement for palliative treatment: results of a multicenter study. Radiology. 1998; 209:117–120. PMID: 9769821.
17. Fernández Lobato R, Pinto I, Paul L, et al. Self-expanding prostheses as a palliative method in treating advanced colorectal cancer. Int Surg. 1999; 84:159–162. PMID: 10408289.
18. Liberman H, Adams DR, Blatchford GJ, Ternent CA, Christensen MA, Thorson AG. Clinical use of the self-expanding metallic stent in the management of colorectal cancer. Am J Surg. 2000; 180:407–411. PMID: 11182388.
Article
19. Carne PW, Frye JN, Robertson GM, Frizelle FA. Stents or open operation for palliation of colorectal cancer: a retrospective, cohort study of perioperative outcome and long-term survival. Dis Colon Rectum. 2004; 47:1455–1461. PMID: 15486741.
Article
20. Ptok H, Marusch F, Steinert R, Meyer L, Lippert H, Gastinger I. Incurable stenosing colorectal carcinoma: endoscopic stent implantation or palliative surgery? World J Surg. 2006; 30:1481–1487. PMID: 16850152.
Article
21. Karoui M, Charachon A, Delbaldo C, et al. Stents for palliation of obstructive metastatic colon cancer: impact on management and chemotherapy administration. Arch Surg. 2007; 142:619–623. PMID: 17638798.
22. 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
23. Súarez J, Jiménez J, Vera R, et al. Stent or surgery for incurable obstructive colorectal cancer: an individualized decision. Int J Colorectal Dis. 2010; 25:91–96. PMID: 19859722.
24. 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
25. 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
26. Jiménez-Pérez J, Casellas J, García-Cano J, et al. Colonic stenting as a bridge to surgery in malignant large-bowel obstruction: a report from two large multinational registries. Am J Gastroenterol. 2011; 106:2174–2180. PMID: 22085816.
Article
27. Inaba Y, Arai Y, Yamaura H, et al. Phase II clinical study on stent therapy for unresectable malignant colorectal obstruction (JIVROSG-0206). Am J Clin Oncol. 2012; 35:73–76. PMID: 21293242.
Article
28. Luigiano C, Ferrara F, Fabbri C, et al. Through-the-scope large diameter self-expanding metal stent placement as a safe and effective technique for palliation of malignant colorectal obstruction: a single center experience with a long-term follow-up. Scand J Gastroenterol. 2011; 46:591–596. PMID: 21271788.
Article
29. 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
30. 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.
31. Caceres A, Zhou Q, Iasonos A, Gerdes H, Chi DS, Barakat RR. Colorectal stents for palliation of large-bowel obstructions in recurrent gynecologic cancer: an updated series. Gynecol Oncol. 2008; 108:482–485. PMID: 18190953.
Article
32. Miyayama S, Matsui O, Kifune K, et al. Malignant colonic obstruction due to extrinsic tumor: palliative treatment with a self-expanding nitinol stent. AJR Am J Roentgenol. 2000; 175:1631–1637. PMID: 11090392.
33. Kim JH, Song HY, Park JH, Ye BD, Yoon YS, Kim JC. Metallic stent placement in the palliative treatment of malignant colonic obstructions: primary colonic versus extracolonic malignancies. J Vasc Interv Radiol. 2011; 22:1727–1732. PMID: 21937243.
Article
34. 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
35. 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; 26:215–218. PMID: 21207043.
Article
36. Keränen I, Lepistö A, Udd M, Halttunen J, Kylänpää L. Stenting for malignant colorectal obstruction: a single-center experience with 101 patients. Surg Endosc. 2012; 26:423–430. PMID: 21909857.
Article
37. Small AJ, Young-Fadok TM, Baron TH. Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases. Surg Endosc. 2008; 22:454–462. PMID: 17704890.
Article
38. Keränen I, Lepistö A, Udd M, Halttunen J, Kylänpää L. Outcome of patients after endoluminal stent placement for benign colorectal obstruction. Scand J Gastroenterol. 2010; 45:725–731. PMID: 20205505.
Article
39. Levine RA, Wasvary H, Kadro O. Endoprosthetic management of refractory ileocolonic anastomotic strictures after resection for Crohn's disease: report of nine-year follow-up and review of the literature. Inflamm Bowel Dis. 2012; 18:506–512. PMID: 21542067.
Article
40. Stienecker K, Gleichmann D, Neumayer U, Glaser HJ, Tonus C. Long-term results of endoscopic balloon dilatation of lower gastrointestinal tract strictures in Crohn's disease: a prospective study. World J Gastroenterol. 2009; 15:2623–2627. PMID: 19496192.
Article
41. Farrell JJ. Preoperative colonic stenting: how, when and why? Curr Opin Gastroenterol. 2007; 23:544–549. PMID: 17762561.
Article
42. Keymling M. Colorectal stenting. Endoscopy. 2003; 35:234–238. PMID: 12584644.
Article
43. Repici A, Pagano N, Hervoso CM, et al. Metal stents for malignant colorectal obstruction. Minim Invasive Ther Allied Technol. 2006; 15:331–338. PMID: 17190657.
Article
44. Domingo S, Puértolas S, Gracia-Villa L, Puértolas JA. Mechanical comparative analysis of stents for colorectal obstruction. Minim Invasive Ther Allied Technol. 2007; 16:126–136. PMID: 17474056.
Article
45. 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
46. 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
47. Fregonese D, Naspetti R, Ferrer S, et al. Ultraflex precision colonic stent placement as a bridge to surgery in patients with malignant colon obstruction. Gastrointest Endosc. 2008; 67:68–73. PMID: 18028916.
Article
48. 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; 67:478–488. PMID: 18294511.
49. Kim JH, Song HY, Li YD, et al. Dual-design expandable colorectal stent for malignant colorectal obstruction: comparison of flared ends and bent ends. AJR Am J Roentgenol. 2009; 193:248–254. PMID: 19542421.
Article
50. Shim CS, Cho JY, Jung IS, et al. Through-the-scope double colonic stenting in the management of inoperable proximal malignant colonic obstruction: a pilot study. Endoscopy. 2004; 36:426–431. PMID: 15100952.
Article
51. Li YD, Cheng YS, Li MH, et al. Management of acute malignant colorectal obstruction with a novel self-expanding metallic stent as a bridge to surgery. Eur J Radiol. 2010; 73:566–571. PMID: 19167177.
Article
52. 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
53. Song HY, Kim JH, Shin JH, et al. A dual-design expandable colorectal stent for malignant colorectal obstruction: results of a multicenter study. Endoscopy. 2007; 39:448–454. PMID: 17516352.
Article
54. 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
55. 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
56. 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
57. Moon CM, Kim TI, Lee MS, et al. Comparison of a newly designed double-layered combination covered stent and D-weave uncovered stent for decompression of obstructive colorectal cancer: a prospective multicenter study. Dis Colon Rectum. 2010; 53:1190–1196. PMID: 20628284.
Article
58. Choi JS, Choo SW, Park KB, et al. Interventional management of malignant colorectal obstruction: use of covered and uncovered stents. Korean J Radiol. 2007; 8:57–63. PMID: 17277564.
Article
59. 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
60. Langevin JM, Nivatvongs S. The true incidence of synchronous cancer of the large bowel. A prospective study. Am J Surg. 1984; 147:330–333. PMID: 6703204.
61. Slater G, Aufses AH Jr, Szporn A. Synchronous carcinoma of the colon and rectum. Surg Gynecol Obstet. 1990; 171:283–287. PMID: 2218832.
62. Ekelund GR, Pihl B. Mutiple carcinomas of the colon and rectum. Cancer. 1974; 33:1630–1634. PMID: 4834157.
63. Adloff M, Arnaud JP, Bergamaschi R, Schloegel M. Synchronous carcinoma of the colon and rectum: prognostic and therapeutic implications. Am J Surg. 1989; 157:299–302. PMID: 2537586.
Article
64. Pagana TJ, Ledesma EJ, Mittelman A, Nava HR. The use of colonoscopy in the study of synchronous colorectal neoplasms. Cancer. 1984; 53:356–359. PMID: 6690019.
Article
65. Vitale MA, Villotti G, d'Alba L, Frontespezi S, Iacopini F, Iacopini G. Preoperative colonoscopy after self-expandable metallic stent placement in patients with acute neoplastic colon obstruction. Gastrointest Endosc. 2006; 63:814–819. PMID: 16650544.
Article
66. 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
67. 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.
68. Donnellan F, Cullen G, Cagney D, et al. Efficacy and safety of colonic stenting for malignant disease in the elderly. Int J Colorectal Dis. 2010; 25:747–750. PMID: 20213457.
Article
69. Sagar J. Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev. 2011; (11):CD007378. PMID: 22071835.
Article
70. Lopera JE, De Gregorio MA. Fluoroscopic management of complications after colorectal stent placement. Gut Liver. 2010; 4(Suppl 1):S9–S18. PMID: 21103302.
Article
71. Repici A, de Paula Pessoa Ferreira D. Expandable metal stents for malignant colorectal strictures. Gastrointest Endosc Clin N Am. 2011; 21:511–533. PMID: 21684468.
Article
72. 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
73. Park JK, Lee MS, Ko BM, et al. Outcome of palliative self-expanding metal stent placement in malignant colorectal obstruction according to stent type and manufacturer. Surg Endosc. 2011; 25:1293–1299. PMID: 20976501.
Article
74. Branger F, Thibaudeau E, Mucci-Hennekinne S, et al. Management of acute malignant large-bowel obstruction with self-expanding metal stent. Int J Colorectal Dis. 2010; 25:1481–1485. PMID: 20607252.
Article
75. Fernández-Esparrach G, Bordas JM, Giráldez MD, et al. Severe complications limit long-term clinical success of self-expanding metal stents in patients with obstructive colorectal cancer. Am J Gastroenterol. 2010; 105:1087–1093. PMID: 19935785.
Article
76. 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
77. Park JH, Oh SH, Lee WY, Choo SW, Do YS, Chun HK. Flexible rectal stent for obstructing colonic neoplasms. J Korean Soc Coloproctol. 2000; 16:267–273.
78. Song HY, Kim JH, Kim KR, et al. Malignant rectal obstruction within 5 cm of the anal verge: is there a role for expandable metallic stent placement? Gastrointest Endosc. 2008; 68:713–720. PMID: 18561924.
Article
79. Rao VS, Al-Mukhtar A, Rayan F, Stojkovic S, Moore PJ, Ahmad SM. Endoscopic laser ablation of advanced rectal carcinoma: a DGH experience. Colorectal Dis. 2005; 7:58–60. PMID: 15606586.
80. Courtney ED, Raja A, Leicester RJ. Eight years experience of high-powered endoscopic diode laser therapy for palliation of colorectal carcinoma. Dis Colon Rectum. 2005; 48:845–850. PMID: 15747077.
Article
81. Eickhoff A, Jakobs R, Schilling D, et al. Prospective nonrandomized comparison of two modes of argon beamer (APC) tumor desobstruction: effectiveness of the new pulsed APC versus forced APC. Endoscopy. 2007; 39:637–642. PMID: 17611919.
Article
82. Horiuchi A, Nakayama Y, Tanaka N, et al. Acute colorectal obstruction treated by means of transanal drainage tube: effectiveness before surgery and stenting. Am J Gastroenterol. 2005; 100:2765–2770. PMID: 16393233.
Article
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