[Self-expanding metallic stent in malignant colonic obstruction]

Area of Science:

• Gastroenterology
• Oncology
• Surgical Oncology

Background:

• Colorectal cancer frequently causes intestinal obstruction, affecting approximately 20% of patients.
• Self-expanding metallic stents (SEMS) offer a minimally invasive option for managing malignant colorectal obstructions.

Purpose of the Study:

• To evaluate the efficacy and safety of SEMS in colorectal cancer obstruction.
• To compare SEMS outcomes with traditional surgical interventions in both palliative and bridge-to-surgery settings.

Main Methods:

• Systematic review and meta-analysis of existing literature on SEMS for colorectal cancer.
• Analysis of desobstruction rates, hospitalisation duration, stoma rates, and mortality.
• Assessment of procedure-related complications, focusing on bowel perforation.

Main Results:

• SEMS achieve desobstruction in over 90% of colorectal cancer obstruction cases.
• In palliative care, SEMS significantly reduce hospitalisation time and permanent stoma rates without increasing mortality compared to surgery.
• As a bridge to surgery, SEMS lead to higher primary stoma rates but lower overall stoma rates, with no significant mortality benefit currently demonstrated.

Conclusions:

• SEMS are highly effective for desobstruction in malignant colorectal obstruction.
• SEMS provide significant benefits in palliative settings, improving patient quality of life and resource utilization.
• Procedure-related bowel perforation is a notable risk, highlighting the need for experienced endoscopists in colonic stenting procedures.