Current mechanisms and techniques for placement of self-expandable metal stents in acute colonic obstruction

Abstract

Acute colonic obstruction, a life-threatening condition often caused by malignant or benign strictures, necessitates rapid and effective intervention to avoid severe complications such as bowel perforation or sepsis. Self-expandable metal stents (SEMS) have emerged as a minimally invasive, effective treatment alternative, either as a bridge to surgery or for palliation in malignant cases. This editorial focuses on the current mechanisms and techniques for SEMS placement in acute colonic obstruction, discussing the various endoscopic approaches, stent design considerations, technical success rates, complications, and long-term outcomes. We explore cutting-edge techniques such as fluoroscopy-free endoscopic placement, two-person colonoscopy, and the use of advanced endoscopic equipment like slim gastroscopes and ultrathin endoscopes. Additionally, the editorial delves into complications associated with SEMS placement, such as stent migration, perforation, and occlusion, and discusses strategies to mitigate these risks. Finally, future directions in SEMS technology, including advancements in stent design and optimal timing for surgery, are presented.

Keywords: Acute colonic obstruction; Self-expandable metal stents; Endoscopic stenting; Colorectal carcinoma; Palliative treatment; Bridge-to-surgery; Technical success; Complications; Stent design; Fluoroscopy-free stenting

Core Tip: This editorial discusses the mechanisms and techniques involved in the placement of self-expandable metal stents (SEMS) in patients with acute colonic obstruction. It highlights recent advancements in endoscopic stenting methods, including fluoroscopy-free techniques and the use of slim and ultrathin endoscopes. The editorial covers the choice of stent design, technical success rates, common complications, and long-term outcomes of SEMS placement. It also explores future directions, including the optimization of stent designs and the timing for subsequent surgery. SEMS represents a significant advancement in the management of acute colonic obstruction, offering a safe and effective alternative to emergency surgery.