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World J Clin Oncol. May 24, 2023; 14(5): 190-197
Published online May 24, 2023. doi: 10.5306/wjco.v14.i5.190
Acute left-sided malignant colonic obstruction: Is there a role for endoscopic stenting?
Salvatore Russo, Rita Conigliaro, Francesca Coppini, Emanuela Dell'Aquila, Giuseppe Grande, Flavia Pigò, Santi Mangiafico, Marinella Lupo, Margherita Marocchi, Helga Bertani, Silvia Cocca
Salvatore Russo, Rita Conigliaro, Giuseppe Grande, Flavia Pigò, Santi Mangiafico, Marinella Lupo, Margherita Marocchi, Helga Bertani, Silvia Cocca, Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Modena 41126, Italy
Francesca Coppini, Gastroenterology and Digestive Endoscopy Unit, Azienda USL, IRCCs di Reggio Emilia, Reggio Emilia 42122, Italy
Emanuela Dell'Aquila, Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome 0144, Italy
Author contributions: Russo S, Cocca S, Coppini F and Dell’Aquila E drafted the manuscript; Conigliaro R, Pigò F, Mangiafico S and Bertani H performed critical revision of the manuscript; Grande G, Marocchi M and Lupo M edited the manuscript and collected the bibliography; All authors have read and approve the final manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the authors or co-authors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salvatore Russo, MD, Doctor, Gastroenterology and Digestive Endoscopy Unit, Modena University Hospital, Via Pietro Giardini 1355, Baggiovara, Modena 41126, Italy. russo.salvatore@aou.mo.it
Received: September 18, 2022
Peer-review started: September 18, 2022
First decision: November 11, 2022
Revised: November 23, 2022
Accepted: April 25, 2023
Article in press: April 25, 2023
Published online: May 24, 2023
Abstract

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.

Keywords: Colorectal neoplasm, Intestinal obstruction, Endoscopy, Self expandable metallic stents, Colorectal surgery, Chemotherapy

Core Tip: Self-expandable metal stents (SEMS) should be considered as a primary option in palliative treatment of malignant left-sided colonic obstruction. In patients with conceivably curable left-sided colon cancer, SEMS placement as a bridge to surgery should be carefully discussed, specifically focusing on lower risk and lower permanent stoma rates, but potentially higher recurrence rates when compared to surgery. In this scenario the endoscopic expertise has a significant impact on the complication rate.