Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16020
Revised: June 12, 2014
Accepted: July 11, 2014
Published online: November 21, 2014
Some colorectal cancer (CRC) patients present symptoms of bowel obstruction, which is considered a surgical emergency. Because of poor medical condition and high incidence of post-surgical complications, there has been increasing use of self-expanding metal stents (SEMS) for the purpose of palliation or as a bridge to surgery with some benefits, including shorter hospital stays, lower rates of adverse events, and one-stage surgery. However, with increasing survival of CRC patients, there have been controversial data on clinical outcomes and complications, compared between SEMS use and surgery for treatment of malignant bowel obstruction. We review recent clinical data on clinical outcomes of SEMS use compared to surgery, including complications.
Core tip: Accumulating evidence has supported the clinical efficacy of self-expanding metal stents (SEMS) placement in patients with malignant colorectal obstruction. As a bridge to surgery or a palliative measure, SEMS placement achieves significantly more beneficial short-term outcomes to relieve obstructive symptoms compared with emergent surgery. Furthermore, SEMS placement can avoid emergent surgery with stoma creation, which increases perioperative morbidity and mortality. However, the negative results of SEMS placements found in recent randomized controlled trials should not be overlooked. For successful outcomes of SEMS placement, the cause of bowel obstruction, purpose of intervention, life expectancy, medical condition, and endoscopic skill should be considered with careful examination on patient status.