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

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.