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World J Gastrointest Endosc. Oct 16, 2013; 5(10): 495-501
Published online Oct 16, 2013. doi: 10.4253/wjge.v5.i10.495
Colorectal stenting as first-line treatment in acute colonic obstruction
Jesús García-Cano
Jesús García-Cano, Department of Digestive Diseases, Hospital Virgen de la Luz, 16002 Cuenca, Spain
Author contributions: García-Cano J wrote the manuscript.
Correspondence to: Jesús García-Cano, MD, PhD, Department of Digestive Diseases, Hospital Virgen de la Luz, Donantes de sangre Street 1, 16002 Cuenca, Spain.
Telephone: +34-96-9179928 Fax: +34-96-9230407
Received: April 14, 2013
Revised: June 16, 2013
Accepted: August 12, 2013
Published online: October 16, 2013

Tumoral obstructions in almost the entire gastrointestinal tract can be resolved with interventional digestive endoscopy techniques. Self-expanding metal stent (SEMS) insertion in the obstructed colon is a minimally invasive and relatively simple procedure providing an effective first-line treatment for relief of acute malignant obstruction symptoms and serving either as a preoperative or “bridge to surgery” procedure or as palliative definitive care. This technique was introduced in the early 1990s. Although there is still debate about its real value, a lot of reports have been published since then and the procedure is advocated by many surgical groups as the method of choice for the initial treatment of left-sided tumoral colonic obstruction. Before the procedure, colonic obstruction has to be diagnosed by abdominal radiographs, water contrast enema and/or a computed tomography scan. The greatest information is provided by the latter and it is perhaps the method of choice prior to stenting. Skills and training are mandatory, as in all interventional procedures. The key step for success is to cross the malignant stricture with a guidewire. Care must be taken not to over insufflate an obstructed colon during the procedure. SEMS slide over the guidewire through the endoscope working channel or in parallel, outside the endoscope. An average 7% perforation rate has been reported during the procedure and other minor complications can appear in the follow up. However, as a whole, this technique seems to compare favorably with surgery.

Keywords: Self-expanding metal stent, Malignant colorectal obstruction, Emergency surgery, Interventional endoscopy