• Crohn’s disease
• endoscopic balloon dilation
• endoscopic mucosal resection
• endoscopic submucosal dissection
• stricturotomy
• ulcerative colitis

Endoscopic placement of a self-expandable metal stent (SEMS) is a minimally invasive treatment for use in malignant and benign colonic obstruction. However, their widespread use is still limited with a nationwide analysis showing only 5.4% of patients with colon obstruction undergoing stent placement. This underutilization could be due to perceived increase risk of complications with stent placement.

To review long- and short-term clinical success of SEMS use for colonic obstruction at our center.

We retrospectively reviewed all the patients who underwent colonic SEMS placement over a eighteen year period (August 2004 through August 2022) at our academic center. Demographics including age, gender, indication (malignant and benign), technical success, clinical success, complications (perforation, stent migration), mortality, and outcomes were recorded.

Sixty three patients underwent colon SEMS over an 18-year period. Fifty-five cases were for malignant indications, 8 were for benign conditions. The benign strictures included diverticular disease stricturing (n = 4), fistula closure (n = 2), extrinsic fibroid compression (n = 1), and ischemic stricture (n = 1). Forty-three of the malignant cases were due to intrinsic obstruction from primary or recurrent colon cancer; 12 were from extrinsic compression. Fifty-four strictures occurred on the left side, 3 occurred on the right and the rest in transverse colon. The total malignant case (n = 55) procedural success rate was 95% vs 100% for benign cases (P = 1.0, NS). Overall complication rate was significantly higher for benign group: Four complications were observed in the malignant group (stent migration, restenosis) vs 2 of 8 (25%) for benign obstruction (1-perforation, 1-stent migration) (P = 0.02). When stratifying complications of perforation and stent migration there was no significant difference between the two groups (P = 0.14, NS).

Colon SEMS remains a worthwhile option for colonic obstruction related to malignancy and has a high procedural and clinical success rate. Benign indications for SEMS placement appear to have similar success to malignant. While there appears to be a higher overall complication rate in benign cases, our study is limited by sample size. When evaluating for perforation alone there does not appear to be any significant difference between the two groups. SEMS placement may be a practical option for indications other that malignant obstruction. Interventional endoscopists should be aware and discuss the risk for complications in setting of benign conditions. Indications in these cases should be discussed in a multi-disciplinary fashion with colorectal surgery.

• Colon cancer
• Obstruction
• malignancy
• Stricture
• Self-expandable metal stent
• Stent migration

Endoscopic luminal stenting (ELS) represents a minimally invasive option for the management of malignant obstruction along the gastrointestinal tract. Previous studies have shown that ELS can provide rapid relief of symptoms related to esophageal, gastric, small intestinal, colorectal, biliary, and pancreatic neoplastic strictures without compromising cancer patients’ overall safety. As a result, in both palliative and neoadjuvant settings, ELS has largely surpassed radiotherapy and surgery as a first-line treatment modality. Following the abovementioned success, the indications for ELS have gradually expanded. To date, ELS is widely used in clinical practice by well-trained endoscopists in managing a wide variety of diseases and complications, such as relieving non-neoplastic obstructions, sealing iatrogenic and non-iatrogenic perforations, closing fistulae and treating post-sphincterotomy bleeding. The abovementioned development would not have been achieved without corresponding advances and innovations in stent technology. However, the technological landscape changes rapidly, making clinicians’ adaptation to new technologies a real challenge. In our mini-review article, by systematically reviewing the relevant literature, we discuss current developments in ELS with regard to stent design, accessories, techniques, and applications, expanding the research basis that was set by previous studies and highlighting areas that need to be further investigated.

• Endoscopic luminal stenting
• Obstruction
• Stricture
• Stenting
• Leak
• Cancer
• Inflammatory bowel disease
• Bariatric surgery

• Biodegradable stent
• Crohn’s disease
• Endoscopic balloon dilation
• Endoscopic treatment
• Inflammatory bowel disease
• Self-expandable metal stent
• Stents
• Strictures

• Abdominal Abscess/etiology
• Abdominal Abscess/surgery
• Algorithms
• Biopsy
• Colectomy
• Colon, Sigmoid/pathology
• Constriction, Pathologic/diagnostic imaging
• Constriction, Pathologic/etiology
• Constriction, Pathologic/therapy
• Diagnosis, Differential
• Dilatation
• Diverticulitis, Colonic/complications
• Diverticulitis, Colonic/surgery
• Humans
• Male
• Middle Aged
• Sigmoid Diseases/diagnostic imaging
• Sigmoid Diseases/etiology
• Sigmoid Diseases/therapy
• Sigmoidoscopy
• Stents
• Tomography, X-Ray Computed

• KL2 TR002539 NCATS NIH HHS

• Animals
• Colon/drug effects
• Colon/pathology
• Gold/chemistry
• Granulation Tissue/drug effects
• Granulation Tissue/pathology
• Male
• Metal Nanoparticles/administration & dosage
• Metal Nanoparticles/chemistry
• Mice
• Mice, Inbred C57BL
• Photothermal Therapy/methods
• Self Expandable Metallic Stents/statistics & numerical data

• National Research Foundation of Korea

Self-expandable metal stent (SEMS) placement has been suggested as a therapeutic modality for treating benign colorectal strictures. Covered stents are generally used, given the concerns regarding the efficacy and safety of uncovered stents. Hence, few studies have evaluated the efficacy and safety of uncovered SEMSs (UCSEMSs) in patients with refractory benign colorectal anastomotic strictures. In this study, 12 patients with postoperative benign symptomatic anastomotic strictures refractory to pneumatic dilation (range, 2–9) and transient indwelling-covered SEMSs were treated using UCSEMS. All enrolled patients were men (mean age, 61 years). Stent placement was successful in all 12 patients, and early clinical success was achieved in 11 (92%) patients. Four patients (25%) showed successful clinical outcomes without further intervention, but eight patients (75%) were clinically unsuccessful, and showed stricture recurrence or functional obstructive symptoms. Three patients underwent surgery, and the remaining five patients required repeat stent procedures. Despite the high reobstruction rate, the median follow-up period after UCSEMS placement was 16.7 months, demonstrating that UCSEMS may be able to achieve medium-term symptom relief without any complications. Therefore, UCSEMS may be an alternative option in exceptional circumstances in carefully selected patients, where invasive surgical treatments, such as stoma diversion, are not an option, thereby improving patients’ quality of life.

• Bowel obstruction
• Colorectal cancer
• Self-expandable metallic stent

• Adult
• Aged
• Colectomy
• Colonoscopy
• Colorectal Neoplasms/complications
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Female
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Prognosis
• Prosthesis Implantation
• Quality of Life
• Retrospective Studies
• Self Expandable Metallic Stents
• Stents
• Survival Analysis
• Treatment Outcome

• Dilatation
• Fibrosis
• Inflammatory bowel diseases
• Self-expandable metal stents
• Stricture

Malignant large bowel obstruction is a surgical emergency that requires urgent decompression. Stents are increasingly being used, though reported outcomes are variable. We describe our multidisciplinary experience in using stents to manage malignant large bowel obstruction.

All patients undergoing colorectal stent insertion for acute large bowel obstruction in a teaching hospital were included. Outcomes, complications, and length of stay (LOS) were recorded.

Over a 7-year period, 73 procedures were performed on 67 patients (37 male, mean age of 76 years). Interventional radiology was involved in all cases. Endoscopic guidance was required in 24 cases (32.9%). In 18 patients (26.9%), treatment intent was to bridge to elective surgery; 16 had successful stent placement; all had subsequent curative resection (laparoscopic resection, 8 of 18; primary anastomosis, 14 of 18). Overall LOS, including both index admission and elective admission, was 16.4 days. Treatment intent was palliative in 49 patients (73.1%). In this group, stents were successfully placed in 41 of 49 (83.7%). Complication rate within 30 days was 20%, including perforation (2 patients), per rectal bleeding (2), stent migration (1), and stent passage (5). Nineteen patients (38.8%) required subsequent stoma formation (6, during same admission; 13, during subsequent admission). Overall LOS was 16.9 days.

In our experience colorectal stents can be used effectively to manage malignant large bowel obstruction, with only selective endoscopic input. As a bridge to surgery, most patients can avoid emergency surgery and have a primary anastomosis. In the palliative setting, the complication rate is acceptable and two-thirds avoid a permanent stoma.

• Colorectal stent
• Large bowel obstruction
• Stoma

• Benign strictures
• Lower gastrointestinal tract
• Self-expandable metal stents

• acute pancreatitis
• bowel complications
• chronic pancreatitis
• gastrointestinal fistula

•

A colonic stent was used to treat colonic stenosis secondary to acute pancreatitis.

We report a patient for whom a colonic stent was successfully used to treat colonic stenosis secondary to acute pancreatitis.

A 70-year-old male presented with epigastric pain. A choledocholith and bile duct dilatation were found on abdominal computed tomography scan. Endoscopic retrograde cholangiopancreatography was performed and a common bile duct stent was placed. Ten hours after stent placement, severe epigastric pain developed. Contrast enhanced abdominal computed tomography scan revealed increased density of fat tissue around the pancreas. He was diagnosed with severe acute pancreatitis and treated in the intensive care unit. On the twenty-eighth hospital day, he vomited. His abdomen was distended and tender to palpation. Contrast enhanced abdominal computed tomography scan revealed stenosis of the descending colon and proximally dilated colon and small bowel. He was diagnosed with colonic stenosis secondary to acute pancreatitis. A colonic stent was placed in the descending colon. Eight months after this episode, elective subtotal colectomy was performed. The postoperative course was unremarkable.

The overall documented leak rate for segmental colectomy with or without on-table lavage following large bowel obstruction is about 4%. In addition, in the acute phase of severe acute pancreatitis, inflammation makes surgery difficult. Use of enteric stents in patients with pancreatitis could be used as a temporizing measure until the inflammation and obstruction improve.

Colonic stenting is useful as a bridge to surgery in the management of large bowel obstruction.

• Acute pancreatitis
• Colonic stenosis
• Colonic stent

• Abscess
• Colonoscopy
• Colovesical
• Complicated
• Diverticulitis
• Fistula
• Obstruction
• Perforation

• Clinical Decision-Making
• Colectomy/methods
• Conservative Treatment/methods
• Disease Progression
• Diverticulitis/diagnostic imaging
• Diverticulitis/physiopathology
• Diverticulitis/therapy
• Diverticulum, Colon/diagnostic imaging
• Diverticulum, Colon/physiopathology
• Diverticulum, Colon/surgery
• Elective Surgical Procedures/methods
• Female
• Humans
• Male
• Prognosis
• Recurrence
• Reoperation/methods
• Reoperation/statistics & numerical data
• Risk Assessment
• Severity of Illness Index
• Treatment Outcome

• Clinical success
• Complications
• Endoscopic stenting
• Predictors of outcome
• Technical success

Colonic complications are rare after acute pancreatitis but are associated with a high mortality. Possible complications include mechanical obstruction, ischaemic necrosis, haemorrhage, and fistula. We report a case of large bowel obstruction in a 31-year-old postpartum female, secondary to severe gallstone pancreatitis. The patient required emergency laparotomy and segmental bowel resection, as well as cholecystectomy. Presentation of obstruction occurs during the acute episode or can be delayed for several weeks. The most common site is the splenic flexure owing to its proximity to the pancreas. Initial management may be conservative, stenting, or surgical. CT is an acceptable baseline investigation in all cases of new onset bowel obstruction. Although bowel obstruction is a rare complication of pancreatitis, clinicians should be aware of it due to its high mortality. Obstruction can occur after a significant delay following the resolution of pancreatitis. Those patients with evidence of colonic involvement on pancreatic imaging warrant further large bowel evaluation. Bowel resection may be required electively or acutely. Colonic stenting has an increasing role in the management of large bowel obstruction but is a modality of treatment that needs further evaluation in this setting.

We assessed the optimal time interval between endoscopic stenting and subsequent surgery in patients with obstructive left-sided colon cancer.

We reviewed the medical records of patients who underwent endoscopic colonic stenting for obstructive left-sided colon cancer between January 2009 and January 2012. Patients who had successful endoscopic intervention as a bridge to surgery were included in the study. Other variables studied were the duration between endoscopic stenting and surgery, the reobstruction rate, the stoma creation rate, the anastomotic leak rate, and the in-hospital mortality rate.

The medical records of 53 patients who underwent endoscopic stenting for obstructive left-sided colon cancer were reviewed, and 43 were included in the study. The median duration between endoscopic stenting and surgery was 7 days (range, 5–33).

A median duration of 7 to 9 days after endoscopic stenting in patients with obstructive left-sided colon cancer is enough time to subsequently perform a safe surgical procedure. Extending this duration may expose the patient to the risk of reobstruction and emergency surgery.

• Bridge to surgery
• Emergency colorectal surgery
• Endoscopic stenting
• Large bowel obstruction

• colorectum
• leak
• migration
• postsurgical stricture
• self-expandable metal stent

• Anastomosis, Surgical
• Colectomy/methods
• Colorectal Neoplasms/complications
• Colorectal Neoplasms/surgery
• Colostomy
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Palliative Care
• Self Expandable Metallic Stents

• Gastrointestinal intervention
• Iatrogenic complications
• Stents

• Colonic obstruction
• Endometriosis
• Stent

AIM: To evaluate the efficacy of stents in treating patients with anastomotic site obstructions due to cancer recurrence following colorectal surgery.

METHODS: The medical records of patients who underwent endoscopic self-expanding metal stents (SEMS) insertion for colorectal obstructions between February 2004 and January 2014 were retrospectively reviewed. During the study period, a total of 218 patients underwent endoscopic stenting for colorectal obstructions. We identified and examined the patients who underwent endoscopic stenting for obstructions caused by cancer recurrence at the anastomotic site following colorectal surgeries for primary colorectal cancer.

RESULTS: Five consecutive patients [mean age, 56.4 years (range: 39-82 years); 4 women, 1 man] underwent endoscopic stenting for obstructions caused by cancer recurrence at the anastomotic site following colorectal surgeries for primary colorectal cancer. Technical and clinical success was achieved in all 5 patients, without any early complications. During follow-up, 3 patients did not need further intervention, prior to their death, after the first stent insertion; thus, the overall success rate was 3/5 (60%). Perforations occurred in 2 patients who required a second SEMS insertion due to re-obstruction; none of the patients experienced stent migration.

CONCLUSION: SEMS placement is a promising treatment option for patients who develop obstructions of their colonic anastomosis sites due to cancer recurrence.

• Colorectal neoplasms
• Endoscopy
• Intestinal obstruction
• Stents
• Surgical anastomosis

• Adult
• Aged
• Aged, 80 and over
• Anastomosis, Surgical
• Colectomy/adverse effects
• Colonic Diseases/etiology
• Colonic Diseases/pathology
• Colonic Diseases/surgery
• Colonoscopy/instrumentation
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Female
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/pathology
• Intestinal Obstruction/surgery
• Male
• Metals
• Middle Aged
• Neoplasm Recurrence, Local/pathology
• Neoplasm Recurrence, Local/surgery
• Palliative Care
• Prosthesis Design
• Reoperation
• Retrospective Studies
• Stents
• Time Factors
• Treatment Outcome

Since its introduction in the early 1990s, the self-expandable metal stent (SEMS) has been increasingly used for the management of malignant colorectal obstruction, not only as a palliative method but also as a preoperative treatment in surgical candidates. However, more recently, concerns have been raised over stent complication rates. Early complications include pain, perforation, and rectal bleeding, and late complications include stent migration and stent obstruction. With the increasing use of SEMS for treatment, physicians need to be more aware of complications occurring after the placement of these stents. This review covers the technical considerations and management of complications after colonic stenting.

• Colon
• Complications
• Stents

• Adult
• Aged
• Aged, 80 and over
• Colectomy
• Colorectal Neoplasms/complications
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/surgery
• Decompression, Surgical/methods
• Drainage/methods
• Female
• Follow-Up Studies
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/mortality
• Intestinal Obstruction/surgery
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Retrospective Studies
• Survival Rate
• Treatment Outcome

• Benign disease
• colorectal obstruction
• efficacy
• safety
• stent

• Esophagus
• Self-expanding metal stent
• Stent complication
• Stent fracture
• Stent migration

• Aged
• Alloys
• Deglutition Disorders/etiology
• Device Removal/methods
• Dilatation
• Esophageal Stenosis/diagnosis
• Esophageal Stenosis/etiology
• Esophageal Stenosis/therapy
• Esophagoscopy/adverse effects
• Esophagoscopy/instrumentation
• Female
• Foreign-Body Migration/diagnosis
• Foreign-Body Migration/etiology
• Foreign-Body Migration/therapy
• Humans
• Prosthesis Design
• Prosthesis Failure
• Recurrence
• Risk Factors
• Stents
• Treatment Outcome

• colectomy
• colostomy
• endoscopic stent
• large bowel obstruction
• management

Recent technological advances in colonoscopy have led to improvements in both image enhancement and procedural performance. However, the utility of these technological advancements remain dependent on the quality of bowel preparation during colonoscopy. Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance, such as reduced cecal intubation rates, increased patient discomfort and lower adenoma detection. The most popular bowel preparation regimes currently used are based on either Polyethylene glycol-electrolyte, a non-absorbable solution, or aqueous sodium phosphate, a low-volume hyperosmotic solution. Statements from various international societies and several reviews have suggested that the efficacy of bowel preparation regimes based on both purgatives are similar, although patients’ compliance with these regimes may differ somewhat. Many studies have now shown that factors other than the type of bowel preparation regime used, can influence the quality of bowel preparation among adult patients undergoing colonoscopy. These factors can be broadly categorized as either patient-related or procedure-related. Studies from both Asia and the West have identified patient-related factors such as an increased age, male gender, presence of co-morbidity and socio-economic status of patients to be associated with poor bowel preparation among adults undergoing routine out-patient colonoscopy. Additionally, procedure-related factors such as adherence to bowel preparation instructions, timing of bowel purgative administration and appointment waiting times for colonoscopy are recognized to influence the quality of colon cleansing. Knowledge of these factors should aid clinicians in modifying bowel preparation regimes accordingly, such that the quality of colonoscopy performance and delivery of service to patients can be optimised.

• Bowel preparation
• Colonoscopy
• Risk factors
• Quality

AIM: To verify the clinical results of the endoscopic stenting procedure for colorectal obstructions followed by laparoscopic colorectal resection with “one stage anastomosis”.

METHODS: From March 2003 to March 2009 in our surgical department, 48 patients underwent endoscopic stenting for colorectal occlusive lesion: 30 males (62.5%) and 18 females (37.5%) with an age range from 40 years to 92 years (median age 69.5). All patients enrolled in our study were diagnosed with an intestinal obstruction originating from the colorectal tract without bowel perforation signs. Obstruction was primitive colorectal cancer in 45 cases (93.7%) and benign anastomotic stricture in 3 cases (6.3%).

RESULTS: Surgical resection was totally laparoscopic in 69% of cases (24 patients) while 17% (6 patients) of cases were video-assisted due to the local extension of cancer with infiltrations of surrounding structures (urinary bladder in 2 cases, ileus and iliac vessels in the others). In 14% of cases (5 patients), resection was performed by open surgery due to the high American Society of Anesthesiologists score and the elderly age of patients (median age of 89 years). We performed a terminal stomy in only 7 patients out of 35, 6 colostomies and one ileostomy (in a total colectomy). In the other 28 cases (80%), we performed bowel anastomosis at the same time as resection, employing a temporary ileostomy only in 5 cases.

CONCLUSION: Colorectal stenting transforms an emergency operation in to an elective operation performable in a totally laparoscopic manner, limiting the confection of colostomy with its correlated complications.

• Colorectal cancer
• Laparoscopy
• Colonic stenting
• Intestinal obstruction
• Endoscopy

• Aged
• Aged, 80 and over
• Colonic Diseases/etiology
• Colonic Diseases/therapy
• Colonoscopy/adverse effects
• Colonoscopy/instrumentation
• Colonoscopy/methods
• Constriction, Pathologic/complications
• Constriction, Pathologic/therapy
• Female
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/therapy
• Male
• Middle Aged
• Rectal Diseases/etiology
• Rectal Diseases/therapy
• Retrospective Studies