Acute left-sided malignant colonic obstruction: Is there a role for endoscopic stenting?

Abstract

The therapy of left-sided malignant colonic obstruction continues to be one of the largest problems in clinical practice. Numerous studies on colonic stenting for neoplastic colonic obstruction have been reported in the last decades. Thereby the role of self-expandable metal stents (SEMS) in the treatment of malignant colonic obstruction has become better defined. However, numerous prospective and retrospective investigations have highlighted serious concerns about a possible worse outcome after endoscopic colorectal stenting as a bridge to surgery, particularly in case of perforation. This review analyzes the most recent evidence in order to highlight pros and cons of SEMS placement in left-sided malignant colonic obstruction.

Keywords: Colorectal neoplasm; Intestinal obstruction; Endoscopy; Self expandable metallic stents; Colorectal surgery; Chemotherapy

Core Tip: Self-expandable metal stents (SEMS) should be considered as a primary option in palliative treatment of malignant left-sided colonic obstruction. In patients with conceivably curable left-sided colon cancer, SEMS placement as a bridge to surgery should be carefully discussed, specifically focusing on lower risk and lower permanent stoma rates, but potentially higher recurrence rates when compared to surgery. In this scenario the endoscopic expertise has a significant impact on the complication rate.