Minimally invasive, maximum impact: advances in the application of colonic stents

Malignant colorectal obstruction (MCO) is a common and life-threatening presentation of colorectal cancer, traditionally managed with emergency surgery associated with high morbidity and high stoma rates. Self-expanding metal stents (SEMS) have emerged as an important alternative for both palliation and as a bridge to curative resection. This review summarizes recent advances in indications, technical aspects, and emerging applications of colonic stenting, highlighting its role in modern multidisciplinary care.

Current evidence supports the use of SEMS as one of the first-line palliative approaches in selected patients, providing rapid symptom relief and reducing the need for permanent stomas. In carefully selected patients, colonic SEMS can convert urgent high-risk operations into planned resections, facilitating minimally invasive approaches, though concerns remain regarding perforation risk and long-term oncologic outcomes. Increasing operator expertise, device innovation, and technical advances continue to improve safety and success rates. Beyond malignancy, expanding applications include refractory benign strictures, diverticular obstruction, and the use of lumen-apposing metal stents (LAMS) in inflammatory bowel disease and anastomotic complications.

Colonic stenting has emerged as a valuable alternative to surgery for the management of MCO and is being investigated in select benign conditions, though broader adoption requires further evidence. Future research should refine patient selection, compare stenting with surgical alternatives, and clarify long-term outcomes.