Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2019; 11(3): 193-208
Published online Mar 16, 2019. doi: 10.4253/wjge.v11.i3.193
Acute abdominal obstruction: Colon stent or emergency surgery? An evidence-based review
Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Christopher C Thompson, Eduardo Guimarães Hourneaux de Moura
Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Eduardo Guimarães Hourneaux de Moura, Gastrointestinal Endoscopy Unit, Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo 05403-000, Brazil
Diogo Turiani Hourneaux de Moura, Christopher C Thompson, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Author contributions: Ribeiro IB contributed to acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; de Moura DTH and Ribeiro IB contributed to analysis and interpretation of data, revising the article; Thompson CC acquisition of data, drafting the article, revising the article; Thompson CC revising the article and the English; de Moura EGH contributed to conception and design of the study, critical revision, final approval.
Supported by the Research Ethics Committee of the University of Sã o Paulo School of Medicine Hospital das Clí nicas.
Conflict-of-interest statement: Thompson C is a consultant to Boston Scientific and Olympus; de Moura EGH is a consultant to Boston Scientific; all other authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Igor Braga Ribeiro, MD, Academic Fellow, Surgeon, Gastrointestinal Endoscopy Unit, Department of Endoscopy of Clinics Hospital of São Paulo University, Av. Dr. Enéas de Carvalho Aguiar, 255, Instituto Central, Prédio dos Ambulatórios, Pinheiros, São Paulo 05403-000, Brazil. igorbraga1@gmail.com
Telephone: +55-92-981377788
Received: January 16, 2019
Peer-review started: January 17, 2019
First decision: January 26, 2019
Revised: January 29, 2019
Accepted: February 13, 2019
Article in press: February 13, 2019
Published online: March 16, 2019
Processing time: 59 Days and 19.1 Hours
Abstract

According to the American Cancer Society and Colorectal Cancer Statistics 2017, colorectal cancer (CRC) is one of the most common malignancies in the United States and the second leading cause of cancer death in the world in 2018. Previous studies demonstrated that 8%-29% of patients with primary CRC present malignant colonic obstruction (MCO). In the past, emergency surgery has been the primary treatment for MCO, although morbidity and surgical mortality rates are higher in these settings than in elective procedures. In the 1990s, self-expanding metal stents appeared and was a watershed in the treatment of patients in gastrointestinal surgical emergencies. The studies led to high expectations because the use of stents could prevent surgical intervention, such as colostomy, leading to lower morbidity and mortality, possibly resulting in higher quality of life. This review was designed to provide present evidence of the indication, technique, outcomes, benefits, and risks of these treatments in acute MCO through the analysis of previously published studies and current guidelines.

Keywords: Colorectal cancer; Endoscopy; Stent; Surgery; Palliative

Core tip: This review was designed to provide present evidence of the indication, technique, outcomes, benefits, and risks of colon stenting and emergency surgery in acute malignant colonic obstruction through the analysis of previously published studies with 1A evidence and current guidelines.