• bridge-to-surgery
• colon cancer
• obstruction
• palliative interventional endoscopy
• self-expandable metal stents

• acute colon cancer obstruction
• bridge to surgery
• neoadjuvant chemotherapy
• self‐expanding metallic stent
• survival outcomes

• Humans
• Colonic Neoplasms/complications
• Colonic Neoplasms/mortality
• Colonic Neoplasms/surgery
• Self Expandable Metallic Stents
• Intestinal Obstruction/etiology
• Intestinal Obstruction/therapy
• Intestinal Obstruction/surgery
• Intestinal Obstruction/mortality
• Treatment Outcome
• Survival Rate
• Female
• Male

• 82070685 National Natural Science Foundation of China
• CYDXK202206 Multidisciplinary Clinical Research Innovation Team Project of Beijing Chaoyang Hospital
• PX2019012 Beijing Municipal Administration of Hospitals Incubating Program

• colonic obstruction
• colorectal cancer
• emergency
• guidelines
• surgery

• colonic stent
• colorectal cancer
• large bowel obstruction

• bridge to surgery
• colorectal cancer
• obstruction
• self-expandable metallic stent
• stage IV

• Humans
• Propensity Score
• Male
• Colorectal Neoplasms/surgery
• Colorectal Neoplasms/complications
• Colorectal Neoplasms/pathology
• Female
• Retrospective Studies
• Self Expandable Metallic Stents
• Aged
• Middle Aged
• Neoplasm Staging
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Treatment Outcome
• Laparoscopy/methods
• Aged, 80 and over

• Colonoscopy
• Colorectal neoplasms
• Intestinal obstruction
• Self expandable metallic stents

• CT scan
• acute colonic obstruction
• antiangiogenic agents
• bridge to surgery
• colorectal cancer
• endoscopic stent
• self-expandable metal stent

The therapy of left-sided malignant colonic obstruction continues to be one of the largest problems in clinical practice. Numerous studies on colonic stenting for neoplastic colonic obstruction have been reported in the last decades. Thereby the role of self-expandable metal stents (SEMS) in the treatment of malignant colonic obstruction has become better defined. However, numerous prospective and retrospective investigations have highlighted serious concerns about a possible worse outcome after endoscopic colorectal stenting as a bridge to surgery, particularly in case of perforation. This review analyzes the most recent evidence in order to highlight pros and cons of SEMS placement in left-sided malignant colonic obstruction.

• Colorectal neoplasm
• Intestinal obstruction
• Endoscopy
• Self expandable metallic stents
• Colorectal surgery
• Chemotherapy

• Bridge to surgery
• Chemotherapy
• Colonic stents
• European Society of Gastrointestinal Endoscopy guidelines
• Long-term outcomes
• Obstructive left-sided colon cancer

• Bridge to surgery
• Colon cancer
• Colorectal surgery
• Emergency treatment
• Intestinal obstruction
• Self-expandable metal stent

• MIS-C
• free thyroxine
• thyroid function
• free triiodothyronine

• FAERS
• Perforated appendicitis
• adverse events
• bevacizumab
• interferon
• medications
• multiple sclerosis
• pharmacovigilance
• rheumatoid arthritis

• Female
• United States/epidemiology
• Humans
• Male
• United States Food and Drug Administration
• Adverse Drug Reaction Reporting Systems
• Appendicitis/chemically induced
• Appendicitis/epidemiology
• Pharmacovigilance
• Databases, Factual

• colon cancer
• intestinal obstruction
• palliative therapy
• self‐expandable metal stent
• surgical stomas

Antiangiogenic agents (AAs) are increasingly used to treat malignant tumors and have been associated with gastrointestinal (GI) bleeding and perforation. Elective surgeries and endoscopy are recommended to be delayed for 31 d until after AAs treatment. Data regarding the safety of endoscopy while on antiangiogenic agents is extremely limited. No guidelines are in place to address the concern about withholding these anti-angiogenic drugs.

To evaluate the risks of endoscopy in patients on antiangiogenic agents from 2015 to 2020 at our institution.

This is a single centered retrospective study approved by the institutional review board statement of the institution. Patients that underwent endoscopy within 28 d of antiangiogenic agents’ treatment were included in the study. Primary outcome of interest was death, and secondary outcomes included perforation and GI bleeding. Data were analyzed utilizing descriptive statistics. Fifty-nine patients were included in the final analysis and a total of eighty-five procedures were performed that were characterized as low risk and high risk.

Among the 59 patients a total of 85 endoscopic procedures were performed with 24 (28.2%) categorized as high-risk and 61 (71.8%) procedures as low-risk. Of the total number of patients, (50%) were on bevacizumab and the rest were on imatinib (11.7%), lenvatinib (6.7%) and, ramucirumab (5%). The average duration between administration of AAs and the performance of endoscopic procedures was 9.9 d. No procedure-related adverse events were noted among our study population. We did observe two deaths with one patient, on lenvatinib for metastatic hepatocellular carcinoma, who had persistent bleeding despite esophageal variceal banding and died 4 d later from hemorrhagic shock. Another patient was diagnosed with acute myeloid leukemia died 24 d after an esophagogastroduodenoscopy with biopsy after transition to comfort care.

As per this single center retrospective study, the rate of endoscopic procedure-related adverse events and death within 28 d of AA administration appears to be low.

• Antiangiogenics
• Endoscopy
• Bevacizumab
• Lmatinib
• Lenvatinib
• Adverse events

• Chemotherapy
• Gastrointestinal cancer
• Malignant gastrointestinal obstruction
• Palliative surgery
• Self-expandable metal stent

• Bridge to surgery
• Obstructive colorectal cancer
• SEMS
• Stoma

• Endoscopic stenting
• colorectal cancer
• palliative chemotherapy
• review

• Colorectal Neoplasms/drug therapy
• Humans
• Intestinal Obstruction/etiology
• Palliative Care
• Stents/adverse effects
• Treatment Outcome

Self-expanding metal stents placed during endoscopy are increasingly the first-line treatment for luminal obstruction caused by esophageal, gastroduodenal, and colorectal malignancies in patients who are not candidates for definitive surgical resection. In this review, we provide a practical guide for clinicians to optimise patient and procedure selection for endoscopic stenting in malignant gastrointestinal obstructions. The role of endoscopic stenting in each of the major anatomical systems (esophageal, gastroduodenal, and colorectal) is presented with regard to pre-procedural patient evaluation, procedural techniques, clinical outcomes, and potential complications, as well as post-procedure aftercare.

• Gastroenterostomy
• Gastrointestinal tract
• Gastrojejunostomy
• Stenoses
• Stents

• Endoscopy
• Endoscopy, Gastrointestinal
• Enteral Nutrition
• Gastrostomy
• Humans
• Jejunostomy
• Palliative Care

The strategy for treating obstructive colon cancers with metastatic lesions remains unclear. Herein, we report a case of laparoscopic ileo-transverse colon bypass (LITB) before preoperative chemotherapy for an obstructive right colon cancer.

A 59-year-old woman was referred to our institution (Department of Gastroenterological Surgery, Chiba Cancer Center) for liver tumors detected on ultrasound. The clinical diagnosis was ascending colon cancer with multiple liver metastases. Based on the criteria of the International Union against Cancer Committee, 8th edition, the staging was confirmed as cT4aN1M1a(H), cStage IV. Although the primary tumor in the ascending colon extended beyond the colonic wall, curative resection was possible for both primary and metastatic tumors. We planned to administer chemotherapy before the radical surgery to obtain tumor-free resection margins; however, as the obstruction was fatal, LITB was prioritized and performed using five ports. An intracorporeal side-to-side anastomosis was performed between the ileum, 25 cm from the terminal ileum, and the transverse colon. The patient was discharged on postoperative day 18 without any complications. After LITB, for preoperative chemotherapy, five courses of capecitabine plus oxaliplatin (CapeOX) + bevacizumab were administered. Six weeks after the preoperative chemotherapy, right hemicolectomy with D3 lymph node dissection and right hepatectomy were performed. Pathological findings of the resected specimen confirmed curative resection of both lesions, and a favorable effect of chemotherapy was obtained. The patient has been alive for over 8 months after the surgery, with no evidence of cancer recurrence.

This case report demonstrates the effectiveness of LITB for obstructive right colon cancer in patients who need preoperative chemotherapy.

• Laparoscopic ileo-transverse colon bypass
• Obstructive colon cancer
• Preoperative chemotherapy

• bevacizumab
• chemotherapy
• malignant large bowel obstruction
• obstructive colorectal cancer
• self-expandable metallic stent

• bevacizumab
• case report
• colorectal cancer
• gastrointestinal perforation
• intraluminal stent
• metastatic cancer

• Colorectal cancer
• Emergency surgery
• International guidelines
• Left-sided obstruction
• Long-term outcomes
• SEMS
• Short-term outcomes
• “Bridge to Surgery”

• Colonoscopy/adverse effects
• Colonoscopy/instrumentation
• Colorectal Neoplasms/complications
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/therapy
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/pathology
• Intestinal Obstruction/therapy
• Patient Safety
• Risk Assessment
• Risk Factors
• Self Expandable Metallic Stents
• Treatment Outcome

• Emergency surgery
• Meta-analysis
• Self-expandable metallic stent
• Surgical stomas

• Gastric carcinoma
• Gastric outlet obstruction
• Gastrojejunostomy
• Stent

Bevacizumab, a VEGF‐A inhibitor, in combination with chemotherapy, has proven to increase progression‐free survival (PFS) and overall survival in multiple lines of therapy of metastatic colorectal cancer (mCRC). The angiogenic factor angiopoetin‐2 (Ang‐2) is associated with poor prognosis in many cancers, including mCRC. Preclinical models demonstrate improved activity when inhibiting both VEGF‐A and Ang‐2, suggesting that the dual VEGF‐A and Ang‐2 blocker vanucizumab (RO5520985 or RG‐7221) may improve clinical outcomes. This phase II trial evaluated the efficacy of vanucizumab plus modified (m)FOLFOX‐6 (folinic acid (leucovorin), fluorouracil (5‐FU) and oxaliplatin) versus bevacizumab/mFOLFOX‐6 for first‐line mCRC.

All patients received mFOLFOX‐6 and were randomized 1:1 to also receive vanucizumab 2,000 mg or bevacizumab 5 mg/kg every other week. Oxaliplatin was given for eight cycles; other agents were continued until disease progression or unacceptable toxicity for a maximum of 24 months. The primary endpoint was investigator‐assessed PFS.

One hundred eighty‐nine patients were randomized (vanucizumab, n = 94; bevacizumab, n = 95). The number of PFS events was comparable (vanucizumab, n = 39; bevacizumab, n = 43). The hazard ratio was 1.00 (95% confidence interval, 0.64–1.58; p = .98) in a stratified analysis based on number of metastatic sites and region. Objective response rate was 52.1% and 57.9% in the vanucizumab and bevacizumab arm, respectively. Baseline plasma Ang‐2 levels were prognostic in both arms but not predictive for treatment effects on PFS of vanucizumab. The incidence of adverse events of grade ≥3 was similar between treatment arms (83.9% vs. 82.1%); gastrointestinal perforations (10.8% vs. 8.4%) exceeded previously reported rates in this setting. Hypertension and peripheral edema were more frequent in the vanucizumab arm.

Vanucizumab/mFOLFOX‐6 did not improve PFS and was associated with increased rates of antiangiogenic toxicity compared with bevacizumab/mFOLFOX‐6. Our results suggest that Ang‐2 is not a relevant therapeutic target in first‐line mCRC.

This randomized phase II study demonstrates that additional angiopoietin‐2 (Ang‐2) inhibition does not result in superior benefit over anti–VEGF‐A blockade alone when each added to standard chemotherapy. Moreover, the performed pharmacokinetic and pharmacodynamic analysis revealed that vanucizumab was bioavailable and affected its intended target, thereby strongly suggesting that Ang‐2 is not a relevant therapeutic target in the clinical setting of treatment‐naïve metastatic colorectal cancer. As a result, the further clinical development of the dual VEGF‐A and Ang‐2 inhibitor vanucizumab was discontinued.

This phase II trial evaluated the efficacy of vanucizumab plus mFOLFOX‐6 versus bevacizumab/mFOLFOX‐6 in the first‐line setting of metastatic colorectal cancer.

• Angiopoetin-2
• Bevacizumab
• First-line metastatic colorectal cancer
• VEGF-A
• Vanucizumab

• Antibodies, Monoclonal, Humanized
• Antineoplastic Combined Chemotherapy Protocols/adverse effects
• Bevacizumab/adverse effects
• Camptothecin/therapeutic use
• Colorectal Neoplasms/drug therapy
• Disease-Free Survival
• Fluorouracil/adverse effects
• Humans
• Leucovorin/adverse effects
• Neoplasm Metastasis
• Organoplatinum Compounds/adverse effects

Self-expandable metal stents (SEMSs) are frequently used in the setting of palliation for occluding, inoperable colorectal cancer (CRC). Among possible complications of SEMS positioning, re-obstruction is the most frequent. Its management is controversial, potentially involving secondary stent-in-stent placement, which has been poorly investigated. Moreover, the issue of secondary stent-in-stent re-obstruction and of more-than-two colonic stenting has never been assessed. We describe a case of tertiary SEMS-in-SEMS placement, and also discuss our practice based on available literature.

A 66-year-old male with occluding and metastatic CRC was initially treated by positioning of a SEMS, which had to be revised 6 mo later when a symptomatic intra-stent tumor ingrowth was treated by a SEMS-in-SEMS. We hereby describe an additional episode of intestinal occlusion due to recurrence of intra-stent tumor ingrowth. This patient, despite several negative prognostic factors (splenic flexure location of the tumor, carcinomatosis with ascites, subsequent chemotherapy that included bevacizumab and two previously positioned stents (1 SEMS and 1 SEMS-in-SEMS)) underwent successful management through the placement of a tertiary SEMS-in-SEMS, with immediate clinical benefit and no procedure-related adverse events after 150 d of post-procedural follow-up. This endoscopic management has permitted 27 mo of partial control of a metastatic disease without the need for chemotherapy discontinuation and, ultimately, a good quality of life until death.

Tertiary SEMS-in-SEMS is technically feasible, and appears to be a safe and effective option in the case of recurrent SEMS obstruction.

• Bevacizumab
• Colorectal neoplasms
• Intestinal obstruction
• Palliative care
• Self-expandable metallic stents
• Case report

• Bevacizumab
• Colorectal cancer
• Complication
• Risk factors
• Surgery

• Angiogenesis Inhibitors/adverse effects
• Bevacizumab/adverse effects
• Colorectal Neoplasms/complications
• Colorectal Neoplasms/drug therapy
• Colorectal Neoplasms/pathology
• Colostomy/methods
• Disease Management
• Female
• Follow-Up Studies
• Gastrointestinal Tract/drug effects
• Gastrointestinal Tract/injuries
• Humans
• Intestinal Perforation/chemically induced
• Intestinal Perforation/surgery
• Liver Neoplasms/complications
• Liver Neoplasms/drug therapy
• Liver Neoplasms/secondary
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Risk Factors

• Colon stent
• Colorectal neoplasm
• Mortality
• Outcome
• Stage IV

Self-expanding metal stents can be considered as initial treatment for malignant large bowel obstruction in the palliative setting. It is suggested that systemic anti-angiogenic therapy increases the risk of stent perforation. We report a 65-year-old woman with a metastatic, obstructing colon tumor who has been successfully treated with stent placement and chemoimmunotherapy consisting of capecitabine and bevacizumab for 8 years.

• Bevacizumab
• Chemotherapy
• Colorectal cancer
• Patency
• Self-expanding metal stent

• Angiogenesis Inhibitors/adverse effects
• Angiogenesis Inhibitors/therapeutic use
• Bevacizumab/adverse effects
• Bevacizumab/therapeutic use
• Endoscopy/adverse effects
• Endoscopy/statistics & numerical data
• Female
• Humans
• Male
• Neoplasms/drug therapy
• Receptors, Vascular Endothelial Growth Factor/therapeutic use
• Recombinant Fusion Proteins/adverse effects
• Recombinant Fusion Proteins/therapeutic use
• Retrospective Studies
• Treatment Outcome

• Angiogenesis
• gastric cancer
• human epidermal growth factor receptor 2
• molecular diagnosis
• ramucirumab
• targeted therapy
• the Cancer Genome Atlas
• trastuzumab
• vascular endothelial growth factor

• Antibodies, Monoclonal/adverse effects
• Antibodies, Monoclonal/pharmacology
• Antibodies, Monoclonal/therapeutic use
• Antibodies, Monoclonal, Humanized
• Antineoplastic Agents/adverse effects
• Antineoplastic Agents/pharmacology
• Antineoplastic Agents/therapeutic use
• Humans
• Molecular Targeted Therapy
• Precision Medicine/methods
• Stomach Neoplasms/drug therapy
• Stomach Neoplasms/pathology
• Survival Rate
• Trastuzumab/adverse effects
• Trastuzumab/pharmacology
• Trastuzumab/therapeutic use
• Ramucirumab