Self-expanding metallic stents in colorectal obstructions caused by diverticular disease-a systematic review

The role of self-expanding metallic stents (SEMS) in colorectal obstructions caused by diverticular disease remains uncertain. We aimed to investigate the technical and clinical outcomes related to this procedure, including mortality and complications.

Peer-reviewed and published literature was identified by searching Embase (Ovid), MEDLINE (Ovid), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov the 29th of April 2025. Methodological Index for Non-randomized Studies (MINORS) instrument was used to evaluate study quality. A synthesis without meta-analysis was conducted.

Twenty-seven studies (110 patients) were included, whereof 20 were observational (101 patients) and seven were case studies (9 patients). Of the observational studies, the technical and clinical success was achieved in 92.7% and 83.5% of patients, respectively. Perforation was the most common complication in 13.2% of patients and procedure related mortality was observed in 2.7%. Migration was observed in 8.5% while reobstruction was observed in 5.9%. Bridge-to-surgery was the most common indication for SEMS, with the majority of patients undergoing colorectal surgery, of whom 56.8% avoided stoma.

SEMS in diverticular obstructions are comparable to malignant obstructions besides an increased risk of perforation. Further studies are required to elucidate the role of SEMS as a short-term bridge-to-surgery in diverticular obstructions. The main strength is the identification of inadequate literature and thereby inspiring new research. The main limitation is the high risk of bias in the included literature and the low certainty of the evidence.