Enteral stents for the management of malignant colorectal obstruction
- Todd H Baron, MD
Todd H Baron, MD
- Director of Advanced Therapeutic Endoscopy
- University of North Carolina, Chapel Hill
- Ryan Law, DO
Ryan Law, DO
- Clinical lecturer
- University of Michigan
Enteral stents are used as a nonsurgical alternative for the palliation of luminal gastrointestinal neoplasms, particularly in the esophagus and biliary tract . They are commonly used in the treatment of obstruction in other areas of the gastrointestinal tract, such as the stomach, proximal small bowel, and colon.
This topic will review the use of self-expanding metal stents (SEMS) in the management of malignant colonic obstruction. The surgical management of malignant colonic obstruction and stenting of other portions of the gastrointestinal tract are discussed elsewhere. (See "Use of expandable stents in the esophagus" and "Enteral stents for the palliation of malignant gastroduodenal obstruction" and "Overview of pancreatic stenting and its complications" and "Treatment options for locally advanced cholangiocarcinoma", section on 'Stenting'.)
The indications for stent placement in patients with malignant colonic obstruction include [2-8]:
●Palliation of surgically incurable colorectal cancer. (See "Locoregional methods for management and palliation in patients who present with stage IV colorectal cancer", section on 'Nonsurgical palliative options'.)
●Stenting as a bridge to surgery to avoid an emergent, two-step procedure and to allow for optimization of medical status and for preoperative staging including colonoscopy. (See "Overview of mechanical colorectal obstruction", section on 'Stenting malignant obstruction' and "Clinical presentation, diagnosis, and staging of colorectal cancer".)
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- Kim JW, Jeong JB, Lee KL, et al. Comparison of clinical outcomes between endoscopic and radiologic placement of self-expandable metal stent in patients with malignant colorectal obstruction. Korean J Gastroenterol 2013; 61:22.
- Mauro MA, Koehler RE, Baron TH. Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents. Radiology 2000; 215:659.
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- Watt AM, Faragher IG, Griffin TT, et al. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 2007; 246:24.
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- 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.
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- van Halsema EE, van Hooft JE, Small AJ, et al. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc 2014; 79:970.
- Choi JH, Lee YJ, Kim ES, et al. Covered self-expandable metal stents are more associated with complications in the management of malignant colorectal obstruction. Surg Endosc 2013; 27:3220.
- Kim SJ, Kim HW, Park SB, et al. Colonic perforation either during or after stent insertion as a bridge to surgery for malignant colorectal obstruction increases the risk of peritoneal seeding. Surg Endosc 2015; 29:3499.
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- 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.
- 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.
- Coco C, Cogliandolo S, Riccioni ME, et al. Use of a self-expanding stent in the palliation of rectal cancer recurrences. A report of three cases. Surg Endosc 2000; 14:708.
- Stenting in the setting of adjunctive therapy
- Types of stents
- Covered versus uncovered stents
- PREPROCEDURE TESTING
- PREPROCEDURE PREPARATION
- Bowel preparation
- General considerations
- Approach to evaluating the obstruction
- Placing the stent
- Postprocedure dietary recommendations
- Other factors
- Stenting for palliation
- Stenting as a bridge to surgery
- ADVERSE EVENTS
- Stent migration
- Stent occlusion
- FAILURE TO ACHIEVE COLONIC DECOMPRESSION
- SUMMARY AND RECOMMENDATIONS