Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). This Guideline was also reviewed and endorsed by the Governing Board of the American Society for Gastrointestinal Endoscopy (ASGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.

Main recommendations

The following recommendations should only be applied after a thorough diagnostic evaluation including a contrast-enhanced computed tomography (CT) scan.

1 Prophylactic colonic stent placement is not recommended. Colonic stenting should be reserved for patients with clinical symptoms and imaging evidence of malignant large-bowel obstruction, without signs of perforation (strong recommendation, low quality evidence).

2 Colonic self-expandable metal stent (SEMS) placement as a bridge to elective surgery is not recommended as a standard treatment of symptomatic left-sided malignant colonic obstruction (strong recommendation, high quality evidence).

3 For patients with potentially curable but obstructing left-sided colonic cancer, stent placement may be considered as an alternative to emergency surgery in those who have an increased risk of postoperative mortality, i. e. American Society of Anesthesiologists (ASA) Physical Status ≥ III and/or age > 70 years (weak recommendation, low quality evidence).

4 SEMS placement is recommended as the preferred treatment for palliation of malignant colonic obstruction (strong recommendation, high quality evidence), except in patients treated or considered for treatment with antiangiogenic drugs (e. g. bevacizumab) (strong recommendation, low quality evidence).

• References

• 1 Jemal A, Bray F, Center MM et al. Global cancer statistics. CA Cancer J Clin 2011; 61: 69-90
• 2 Winner M, Mooney SJ, Hershman DL et al. Incidence and predictors of bowel obstruction in elderly patients with stage IV colon cancer: a population-based cohort study. JAMA Surg 2013; 148: 715-722
• 3 Jullumstro E, Wibe A, Lydersen S et al. Colon cancer incidence, presentation, treatment and outcomes over 25 years. Colorectal Dis 2011; 13: 512-518
• 4 Cheynel N, Cortet M, Lepage C et al. Trends in frequency and management of obstructing colorectal cancers in a well-defined population. Dis Colon Rectum 2007; 50: 1568-1575
• 5 Frago R, Ramirez E, Millan M et al. Current management of acute malignant large bowel obstruction: a systematic review. Am J Surg 2014; 207: 127-138
• 6 Fiori E, Lamazza A, De Cesare A et al. Palliative management of malignant rectosigmoidal obstruction. Colostomy vs. endoscopic stenting. A randomized prospective trial. Anticancer Res 2004; 24: 265-268
• 7 Dumonceau JM, Hassan C, Riphaus A et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline Development Policy. Endoscopy 2012; 44: 626-629
• 8 Yoon JY, Jung YS, Hong SP et al. Clinical outcomes and risk factors for technical and clinical failures of self-expandable metal stent insertion for malignant colorectal obstruction. Gastrointest Endosc 2011; 74: 858-868
• 9 Kim JH, Ku YS, Jeon TJ et al. The efficacy of self-expanding metal stents for malignant colorectal obstruction by noncolonic malignancy with peritoneal carcinomatosis. Dis Colon Rectum 2013; 56: 1228-1232
• 10 Song HY, Kim JH, Kim KR et al. Malignant rectal obstruction within 5 cm of the anal verge: is there a role for expandable metallic stent placement?. Gastrointest Endosc 2008; 68: 713-720
• 11 Abbott S, Eglinton TW, Ma Y et al. Predictors of outcome in palliative colonic stent placement for malignant obstruction. Br J Surg 2014; 101: 121-126
• 12 Meisner S, Gonzalez-Huix F, Vandervoort JG et al. Self-expandable metal stents for relieving malignant colorectal obstruction: short-term safety and efficacy within 30 days of stent procedure in 447 patients. Gastrointest Endosc 2011; 74: 876-884
• 13 Choi JH, Lee YJ, Kim ES et al. Covered self-expandable metal stents are more associated with complications in the management of malignant colorectal obstruction. Surg Endosc 2013; 27: 3220-3227
• 14 Donnellan F, Cullen G, Cagney D et al. Efficacy and safety of colonic stenting for malignant disease in the elderly. Int J Colorectal Dis 2010; 25: 747-750
• 15 Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc 2010; 71: 560-572
• 16 Geraghty J, Sarkar S, Cox T et al. Management of large bowel obstruction with self-expanding metal stents. A multicentre retrospective study of factors determining outcome. Colorectal Dis 2014; 16: 476-483
• 17 Biondo S, Pares D, Frago R et al. Large bowel obstruction: predictive factors for postoperative mortality. Dis Colon Rectum 2004; 47: 1889-1897
• 18 Tekkis PP, Kinsman R, Thompson MR et al. The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg 2004; 240: 76-81
• 19 Tan KK, Sim R. Surgery for obstructed colorectal malignancy in an Asian population: predictors of morbidity and comparison between left- and right-sided cancers. J Gastrointest Surg 2010; 14: 295-302
• 20 Frager D, Rovno HD, Baer JW et al. Prospective evaluation of colonic obstruction with computed tomography. Abdom Imaging 1998; 23: 141-146
• 21 Kodeda K, Nathanaelsson L, Jung B et al. Population-based data from the Swedish Colon Cancer Registry. Br J Surg 2013; 100: 1100-1107
• 22 Mulder SA, Kranse R, Damhuis RA et al. Prevalence and prognosis of synchronous colorectal cancer: a Dutch population-based study. Cancer Epidemiol 2011; 35: 442-447
• 23 Latournerie M, Jooste V, Cottet V et al. Epidemiology and prognosis of synchronous colorectal cancers. Br J Surg 2008; 95: 1528-1533
• 24 Papadopoulos V, Michalopoulos A, Basdanis G et al. Synchronous and metachronous colorectal carcinoma. Tech Coloproctol 2004; 8 (Suppl. 01) 97-s100
• 25 Park SH, Lee JH, Lee SS et al. CT colonography for detection and characterisation of synchronous proximal colonic lesions in patients with stenosing colorectal cancer. Gut 2012; 61: 1716-1722
• 26 Cha EY, Park SH, Lee SS et al. CT colonography after metallic stent placement for acute malignant colonic obstruction. Radiology 2010; 254: 774-782
• 27 Lim SG, Lee KJ, Suh KW et al. Preoperative colonoscopy for detection of synchronous neoplasms after insertion of self-expandable metal stents in occlusive colorectal cancer: comparison of covered and uncovered stents. Gut Liver 2013; 7: 311-316
• 28 Vitale MA, Villotti G, d’Alba L et al. Preoperative colonoscopy after self-expandable metallic stent placement in patients with acute neoplastic colon obstruction. Gastrointest Endosc 2006; 63: 814-819
• 29 Nagata K, Ota Y, Okawa T et al. PET/CT colonography for the preoperative evaluation of the colon proximal to the obstructive colorectal cancer. Dis Colon Rectum 2008; 51: 882-890
• 30 Pirlet IA, Slim K, Kwiatkowski F et al. Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc 2011; 25: 1814-1821
• 31 van Hooft JE, Bemelman WA, Oldenburg B et al. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol 2011; 12: 344-352
• 32 Sai VF, Velayos F, Neuhaus J et al. Colonoscopy after CT diagnosis of diverticulitis to exclude colon cancer: a systematic literature review. Radiology 2012; 263: 383-390
• 33 Currie A, Christmas C, Aldean H et al. Systematic review of self-expanding stents in the management of benign colorectal obstruction. Colorectal Dis 2014; 16: 239-245
• 34 Brouwer R, MacDonald A, Matthews R et al. Brush cytology for the diagnosis of colorectal cancer. Dis Colon Rectum 2009; 52: 598-601
• 35 Geramizadeh B, Hooshmand F, Kumar PV. Brush cytology of colorectal malignancies. Acta Cytol 2003; 47: 431-444
• 36 Farouk R, Edwards J, Thorne M et al. Brush cytology for the diagnosis of rectal carcinoma. Br J Surg 1996; 83: 1456-1458
• 37 Chun YJ, Yoon NR, Park JM et al. Prospective assessment of risk of bacteremia following colorectal stent placement. Dig Dis Sci 2012; 57: 1045-1049
• 38 Williams D, Law R, Pullyblank AM. Colorectal stenting in malignant large bowel obstruction: the learning curve. Int J Surg Oncol 2011; doi:
• 39 Lee JH, Yoon JY, Park SJ et al. The learning curve for colorectal stent insertion for the treatment of malignant colorectal obstruction. Gut Liver 2012; 6: 328-333
• 40 Kim SY, Kwon SH, Oh JH. Radiologic placement of uncovered stents for the treatment of malignant colorectal obstruction. J Vasc Interv Radiol 2010; 21: 1244-1249
• 41 Kim H, Kim SH, Choi SY et al. Fluoroscopically guided placement of self-expandable metallic stents and stent-grafts in the treatment of acute malignant colorectal obstruction. J Vasc Interv Radiol 2008; 19: 1709-1716
• 42 Shrivastava V, Tariq O, Tiam R et al. Palliation of obstructing malignant colonic lesions using self-expanding metal stents: a single-center experience. Cardiovasc Intervent Radiol 2008; 31: 931-936
• 43 Kim JH, Song HY, Li YD et al. Dual-design expandable colorectal stent for malignant colorectal obstruction: comparison of flared ends and bent ends. AJR Am J Roentgenol 2009; 193: 248-254
• 44 Alcantara M, Serra X, Bombardo J et al. Colorectal stenting as an effective therapy for preoperative and palliative treatment of large bowel obstruction: 9 years’ experience. Tech Coloproctol 2007; 11: 316-322
• 45 Selinger CP, Ramesh J, Martin DF. Long-term success of colonic stent insertion is influenced by indication but not by length of stent or site of obstruction. Int J Colorectal Dis 2011; 26: 215-218
• 46 Kim JW, Jeong JB, Lee KL et al. Comparison of clinical outcomes between endoscopic and radiologic placement of self-expandable metal stent in patients with malignant colorectal obstruction. Korean J Gastroenterol 2013; 61: 22-29
• 47 Sebastian S, Johnston S, Geoghegan T et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 2004; 99: 2051-2057
• 48 de Gregorio MA, Laborda A, Tejero E et al. Ten-year retrospective study of treatment of malignant colonic obstructions with self-expandable stents. J Vasc Interv Radiol 2011; 22: 870-878
• 49 Tanaka A, Sadahiro S, Yasuda M et al. Endoscopic balloon dilation for obstructive colorectal cancer: a basic study on morphologic and pathologic features associated with perforation. Gastrointest Endosc 2010; 71: 799-805
• 50 Khot UP, Lang AW, Murali K et al. Systematic review of the efficacy and safety of colorectal stents. Br J Surg 2002; 89: 1096-1102
• 51 van Halsema EE, van Hooft JE, Small AJ et al. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc 2014; 79: 970-982 e7
• 52 Zhang Y, Shi J, Shi B et al. Comparison of efficacy between uncovered and covered self-expanding metallic stents in malignant large bowel obstruction: a systematic review and meta-analysis. Colorectal Dis 2012; 14: e367-374
• 53 Yang Z, Wu Q, Wang F et al. A systematic review and meta-analysis of randomized trials and prospective studies comparing covered and bare self-expandable metal stents for the treatment of malignant obstruction in the digestive tract. Int J Med Sci 2013; 10: 825-835
• 54 Kim BC, Han KS, Hong CW et al. Clinical outcomes of palliative self-expanding metallic stents in patients with malignant colorectal obstruction. J Dig Dis 2012; 13: 258-266
• 55 Manes G, de Bellis M, Fuccio L et al. Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent: analysis of results and predictors of outcomes in a large multicenter series. Arch Surg 2011; 146: 1157-1162
• 56 Im JP, Kim SG, Kang HW et al. Clinical outcomes and patency of self-expanding metal stents in patients with malignant colorectal obstruction: a prospective single center study. Int J Colorectal Dis 2008; 23: 789-794
• 57 Baron TH, Wong KeeSong LM, Repici A. Role of self-expandable stents for patients with colon cancer (with videos). Gastrointest Endosc 2012; 75: 653-662
• 58 Cheung DY, Kim JY, Hong SP et al. Outcome and safety of self-expandable metallic stents for malignant colon obstruction: a Korean multicenter randomized prospective study. Surg Endosc 2012; 26: 3106-3113
• 59 Park JK, Lee MS, Ko BM et al. Outcome of palliative self-expanding metal stent placement in malignant colorectal obstruction according to stent type and manufacturer. Surg Endosc 2011; 25: 1293-1299
• 60 Small AJ, Baron TH. Comparison of Wallstent and Ultraflex stents for palliation of malignant left-sided colon obstruction: a retrospective, case-matched analysis. Gastrointest Endosc 2008; 67: 478-488
• 61 Garcia-Cano J, Gonzalez-Huix F, Juzgado D et al. Use of self-expanding metal stents to treat malignant colorectal obstruction in general endoscopic practice (with videos). Gastrointest Endosc 2006; 64: 914-920
• 62 Cho YK, Kim SW, Lee BI et al. Clinical outcome of self-expandable metal stent placement in the management of malignant proximal colon obstruction. Gut Liver 2011; 5: 165-710
• 63 Yao LQ, Zhong YS, Xu MD et al. Self-expanding metallic stents drainage for acute proximal colon obstruction. World J Gastroenterol 2011; 17: 3342-3346
• 64 Repici A, Adler DG, Gibbs CM et al. Stenting of the proximal colon in patients with malignant large bowel obstruction: techniques and outcomes. Gastrointest Endosc 2007; 66: 940-944
• 65 Kim JY, Kim SG, Im JP et al. Comparison of treatment outcomes of endoscopic stenting for colonic and extracolonic malignant obstruction. Surg Endosc 2013; 27: 272-277
• 66 Dronamraju SS, Ramamurthy S, Kelly SB et al. Role of self-expanding metallic stents in the management of malignant obstruction of the proximal colon. Dis Colon Rectum 2009; 52: 1657-1661
• 67 Gainant A. Emergency management of acute colonic cancer obstruction. J Visc Surg 2012; 149: e3-e10
• 68 Cuffy M, Abir F, Audisio RA et al. Colorectal cancer presenting as surgical emergencies. Surg Oncol 2004; 13: 149-157
• 69 Moon SJ, Kim SW, Lee BI et al. Palliative stent for malignant colonic obstruction by extracolonic malignancy: a comparison with colorectal cancer. Dig Dis Sci 29.09.2013; [Epub ahead of print]
• 70 Keranen I, Lepisto A, Udd M et al. Stenting for malignant colorectal obstruction: a single-center experience with 101 patients. Surg Endosc 2012; 26: 423-430
• 71 Kim BK, Hong SP, Heo HM et al. Endoscopic stenting is not as effective for palliation of colorectal obstruction in patients with advanced gastric cancer as emergency surgery. Gastrointest Endosc 2012; 75: 294-301
• 72 Kim JH, Song HY, Park JH et al. Metallic stent placement in the palliative treatment of malignant colonic obstructions: primary colonic versus extracolonic malignancies. J Vasc Interv Radiol 2011; 22: 1727-1732
• 73 Trompetas V, Saunders M, Gossage J et al. Shortcomings in colonic stenting to palliate large bowel obstruction from extracolonic malignancies. Int J Colorectal Dis 2010; 25: 851-854
• 74 Keswani RN, Azar RR, Edmundowicz SA et al. Stenting for malignant colonic obstruction: a comparison of efficacy and complications in colonic versus extracolonic malignancy. Gastrointest Endosc 2009; 69: 675-680
• 75 Shin SJ, Kim TI, Kim BC et al. Clinical application of self-expandable metallic stent for treatment of colorectal obstruction caused by extrinsic invasive tumors. Dis Colon Rectum 2008; 51: 578-583
• 76 Luigiano C, Ferrara F, Fabbri C et al. Through-the-scope large diameter self-expanding metal stent placement as a safe and effective technique for palliation of malignant colorectal obstruction: a single center experience with a long-term follow-up. Scand J Gastroenterol 2011; 46: 591-596
• 77 Almadi MA, Azzam N, Alharbi O et al. Complications and survival in patients undergoing colonic stenting for malignant obstruction. World J Gastroenterol 2013; 19: 7138-7145
• 78 Jung MK, Park SY, Jeon SW et al. Factors associated with the long-term outcome of a self-expandable colon stent used for palliation of malignant colorectal obstruction. Surg Endosc 2010; 24: 525-530
• 79 Stenhouse A, Page B, Rowan A et al. Self expanding wall stents in malignant colorectal cancer: is complete obstruction a contraindication to stent placement?. Colorectal Dis 2009; 11: 854-858
• 80 Song HY, Kim JH, Shin JH et al. A dual-design expandable colorectal stent for malignant colorectal obstruction: results of a multicenter study. Endoscopy 2007; 39: 448-44
• 81 Huang X, Lv B, Zhang S et al. Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis. J Gastrointest Surg 2014; 18: 584-591
• 82 Cennamo V, Luigiano C, Coccolini F et al. Meta-analysis of randomized trials comparing endoscopic stenting and surgical decompression for colorectal cancer obstruction. Int J Colorectal Dis 2013; 28: 855-863
• 83 Cirocchi R, Farinella E, Trastulli S et al. Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: a systematic review and meta-analysis. Surg Oncol 2013; 22: 14-21
• 84 De Ceglie A, Filiberti R, Baron TH et al. A meta-analysis of endoscopic stenting as bridge to surgery versus emergency surgery for left-sided colorectal cancer obstruction. Crit Rev Oncol Hematol 2013; 88: 387-403
• 85 Tan CJ, Dasari BV, Gardiner K. Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction. Br J Surg 2012; 99: 469-476
• 86 Ye GY, Cui Z, Chen L et al. Colonic stenting vs emergent surgery for acute left-sided malignant colonic obstruction: a systematic review and meta-analysis. World J Gastroenterol 2012; 18: 5608-5615
• 87 Zhang Y, Shi J, Shi B et al. Self-expanding metallic stent as a bridge to surgery versus emergency surgery for obstructive colorectal cancer: a meta-analysis. Surg Endosc 2012; 26: 110-119
• 88 Sagar J. Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Syst Rev 2011; CD007378
• 89 Ghazal AH, El-Shazly WG, Bessa SS et al. Colonic endolumenal stenting devices and elective surgery versus emergency subtotal/total colectomy in the management of malignant obstructed left colon carcinoma. J Gastrointest Surg 2013; 17: 1123-1129
• 90 Tung KL, Cheung HY, Ng LW et al. Endo-laparoscopic approach versus conventional open surgery in the treatment of obstructing left-sided colon cancer: long-term follow-up of a randomized trial. Asian J Endosc Surg 2013; 6: 78-81
• 91 Ho KS, Quah HM, Lim JF et al. Endoscopic stenting and elective surgery versus emergency surgery for left-sided malignant colonic obstruction: a prospective randomized trial. Int J Colorectal Dis 2012; 27: 355-362
• 92 Alcantara M, Serra-Aracil X, Falco J et al. Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg 2011; 35: 1904-1910
• 93 Cheung HY, Chung CC, Tsang WW et al. Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial. Arch Surg 2009; 144: 1127-1132
• 94 Govindarajan A, Naimark D, Coburn NG et al. Use of colonic stents in emergent malignant left colonic obstruction: a Markov chain Monte Carlo decision analysis. Dis Colon Rectum 2007; 50: 1811-1124
• 95 Sloothaak D, van den Berg M, Dijkgraaf M et al. Recurrences after endoscopic stenting as treatment for acute malignant colonic obstruction in the Dutch Stent-In 2 trial. Conference: 21st UEG Week, October 12–16. Berlin: 2013
• 96 Gorissen KJ, Tuynman JB, Fryer E et al. Local recurrence after stenting for obstructing left-sided colonic cancer. Br J Surg 2013; 100: 1805-1809
• 97 Sabbagh C, Browet F, Diouf M et al. Is stenting as “a bridge to surgery” an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Ann Surg 2013; 258: 107-115
• 98 Iversen LH. Aspects of survival from colorectal cancer in Denmark. Dan Med J 2012; 59: B4428
• 99 Symeonidis D, Christodoulidis G, Koukoulis G et al. Colorectal cancer surgery in the elderly: limitations and drawbacks. Tech Coloproctol 2011; 15: 47-50
• 100 Guo MG, Feng Y, Zheng Q et al. Comparison of self-expanding metal stents and urgent surgery for left-sided malignant colonic obstruction in elderly patients. Dig Dis Sci 2011; 56: 2706-2710
• 101 Cui J, Zhang JL, Wang S et al. [A preliminary study of stenting followed by laparoscopic surgery for obstructing left-sided colon cancer]. [In Chinese]. Zhonghua Wei Chang Wai Ke Za Zhi 2011; 14: 40-43
• 102 Lee GJ, Kim HJ, Baek JH et al. Comparison of short-term outcomes after elective surgery following endoscopic stent insertion and emergency surgery for obstructive colorectal cancer. Int J Surg 2013; 11: 442-446
• 103 Kim S, Park Y, Lee K et al. Optimal time of surgery after preoperative self-expandable metalic stent insertion for obstructive colorectal cancer. Dis Colon Rectum 2009; 52: 853
• 104 Liang TW, Sun Y, Wei YC et al. Palliative treatment of malignant colorectal obstruction caused by advanced malignancy: a self-expanding metallic stent or surgery? A system review and meta-analysis. Surg Today 2014; 44: 22-33
• 105 Zhao XD, Cai BB, Cao RS et al. Palliative treatment for incurable malignant colorectal obstructions: a meta-analysis. World J Gastroenterol 2013; 19: 5565-5574
• 106 Carne PW, Frye JN, Robertson GM et al. Stents or open operation for palliation of colorectal cancer: a retrospective, cohort study of perioperative outcome and long-term survival. Dis Colon Rectum 2004; 47: 1455-1461
• 107 Karoui M, Charachon A, Delbaldo C et al. Stents for palliation of obstructive metastatic colon cancer: impact on management and chemotherapy administration. Arch Surg 2007; 142: 619-623 ; discussion 623
• 108 Fiori E, Lamazza A, Schillaci A et al. Palliative management for patients with subacute obstruction and stage IV unresectable rectosigmoid cancer: colostomy versus endoscopic stenting: final results of a prospective randomized trial. Am J Surg 2012; 204: 321-326
• 109 Gianotti L, Tamini N, Nespoli L et al. A prospective evaluation of short-term and long-term results from colonic stenting for palliation or as a bridge to elective operation versus immediate surgery for large-bowel obstruction. Surg Endosc 2013; 27: 832-842
• 110 Yoshida S, Watabe H, Isayama H et al. Feasibility of a new self-expandable metallic stent for patients with malignant colorectal obstruction. Dig Endosc 2013; 25: 160-166
• 111 Huhtinen H, Varpe P, Karvonen J et al. Late complications related to palliative stenting in patients with obstructing colorectal cancer. Minim Invasive Ther Allied Technol 2013; 22: 352-358
• 112 Angenete E, Asplund D, Bergstrom M et al. Stenting for colorectal cancer obstruction compared to surgery – a study of consecutive patients in a single institution. Int J Colorectal Dis 2012; 27: 665-670
• 113 Meisner S, Gonzalez-Huix F, Vandervoort JG et al. Self-expanding metal stenting for palliation of patients with malignant colonic obstruction: effectiveness and efficacy on 255 patients with 12-month’s follow-up. Gastroenterol Res Pract 2012; 2012: 296347 doi: [Epub 2012 Jun 11]
• 114 Yoon JY, Park SJ, Hong SP et al. Outcomes of secondary self-expandable metal stents versus surgery after delayed initial palliative stent failure in malignant colorectal obstruction. Digestion 2013; 88: 46-55
• 115 Yoon JY, Jung YS, Hong SP et al. Outcomes of secondary stent-in-stent self-expandable metal stent insertion for malignant colorectal obstruction. Gastrointest Endosc 2011; 74: 625-633
• 116 Cennamo V, Fuccio L, Mutri V et al. Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy?. Clin Gastroenterol Hepatol 2009; 7: 1174-1176
• 117 Di Mitri R, Mocciaro F, Traina M et al. Self-expandable metal stents for malignant colonic obstruction: Data from a retrospective regional SIED-AIGO study. Dig Liver Dis 2014; 46: 279-282
• 118 Lee HJ, Hong SP, Cheon JH et al. Long-term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers: endoscopic stenting versus surgery. Gastrointest Endosc 2011; 73: 535-542
• 119 Canena JM, Liberato M, Marques I et al. Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction. Rev Esp Enferm Dig 2012; 104: 418-425
• 120 Fernandez-Esparrach G, Bordas JM, Giraldez MD et al. Severe complications limit long-term clinical success of self-expanding metal stents in patients with obstructive colorectal cancer. Am J Gastroenterol 2010; 105: 1087-1093
• 121 Watt AM, Faragher IG, Griffin TT et al. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 2007; 246: 24-30
• 122 Young CJ, Suen MK, Young J et al. Stenting large bowel obstruction avoids a stoma: consecutive series of 100 patients. Colorectal Dis 2011; 13: 1138-1141
• 123 van Hooft JE, Fockens P, Marinelli AW et al. Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy 2008; 40: 184-191
• 124 Ho YH, Siu SK, Buttner P et al. The effect of obstruction and perforation on colorectal cancer disease-free survival. World J Surg 2010; 34: 1091-1101
• 125 Suh JP, Kim SW, Cho YK et al. Effectiveness of stent placement for palliative treatment in malignant colorectal obstruction and predictive factors for stent occlusion. Surg Endosc 2010; 24: 400-406
• 126 Cennamo V, Luigiano C, Manes G et al. Colorectal stenting as a bridge to surgery reduces morbidity and mortality in left-sided malignant obstruction: a predictive risk score-based comparative study. Dig Liver Dis 2012; 44: 508-514
• 127 Jimenez-Perez J, Casellas J, Garcia-Cano J et al. Colonic stenting as a bridge to surgery in malignant large-bowel obstruction: a report from two large multinational registries. Am J Gastroenterol 2011; 106: 2174-2180
• 128 Xinopoulos D, Dimitroulopoulos D, Theodosopoulos T et al. Stenting or stoma creation for patients with inoperable malignant colonic obstructions? Results of a study and cost-effectiveness analysis. Surg Endosc 2004; 18: 421-426