Digestive Disease Interventions 2018; 02(01): 046-052
DOI: 10.1055/s-0038-1639609
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Metallic Stent for Malignant Colorectal Obstruction

Yozo Sato
1   Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
Yoshitaka Inaba
1   Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
› Author Affiliations
Further Information

Publication History

20 November 2017

13 February 2018

Publication Date:
20 April 2018 (online)


Acute colorectal obstruction has been often reported as a secondary outcome of left-colonic malignancy. It is considered as a common emergency condition. Self-expandable metallic stent (SEMS) placement is widely used as a palliative treatment for the management of malignant colorectal obstruction (MCRO). SEMS placement is also deliberated as a bridge to surgery. With advances in technology, several recent studies of SEMS placement for MCRO indicated high technical (94–98%) and clinical (91–93%) success rates. The complication rate associated with SEMS is quite acceptable. However, long-term outcomes are still unclear. The symptoms should be carefully monitored before application of SEMS, particularly in patients who are eligible for systemic chemotherapy and in patients with a long life expectancy because of late complications such as reobstruction, stent migration, and perforation. Appropriate patient selection and placement technique are keys for the successful implementation of SEMS.

  • References

  • 1 Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61 (02) 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 (08) 715-722
  • 3 Jullumstrø E, Wibe A, Lydersen S, Edna TH. Colon cancer incidence, presentation, treatment and outcomes over 25 years. Colorectal Dis 2011; 13 (05) 512-518
  • 4 Cheynel N, Cortet M, Lepage C, Benoit L, Faivre J, Bouvier AM. Trends in frequency and management of obstructing colorectal cancers in a well-defined population. Dis Colon Rectum 2007; 50 (10) 1568-1575
  • 5 Breitenstein S, Rickenbacher A, Berdajs D, Puhan M, Clavien PA, Demartines N. Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction. Br J Surg 2007; 94 (12) 1451-1460
  • 6 Cuffy M, Abir F, Audisio RA, Longo WE. Colorectal cancer presenting as surgical emergencies. Surg Oncol 2004; 13 (2-3): 149-157
  • 7 Newton K, Hill J. Colonic cancer: the current role of stent insertion. Gastrointest Interv 2017; 6: 118-121
  • 8 Song HY, Nam DH, Lee H. Usefulness of a guiding sheath for fluoroscopic colorectal stent placement. Korean J Radiol 2012; 13 (Suppl. 01) S83-S88
  • 9 Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 2004; 99 (10) 2051-2057
  • 10 Huang X, Lv B, Zhang S, Meng L. Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis. J Gastrointest Surg 2014; 18 (03) 584-591
  • 11 Lee JM, Byeon JS. Colorectal stents: current status. Clin Endosc 2015; 48 (03) 194-200
  • 12 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 (06) 855-863
  • 13 Sloothaak DA, van den Berg MW, Dijkgraaf MG. , et al; collaborative Dutch Stent-In study group. Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg 2014; 101 (13) 1751-1757
  • 14 van Hooft JE, van Halsema EE, Vanbiervliet G. , et al; European Society of Gastrointestinal Endoscopy (ESGE). Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Gastrointest Endosc 2014; 80 (05) 747-61.e1 , 75
  • 15 Saito S, Yoshida S, Isayama H. , et al. A prospective multicenter study on self-expandable metallic stents as a bridge to surgery for malignant colorectal obstruction in Japan: efficacy and safety in 312 patients. Surg Endosc 2016; 30 (09) 3976-3986
  • 16 van Hooft JE, Bemelman WA, Oldenburg B. , et al; collaborative Dutch Stent-In study group. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol 2011; 12 (04) 344-352
  • 17 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 (06) 970-82.e7 , quiz 983.e2, 983.e5
  • 18 Zhao XD, Cai BB, Cao RS, Shi RH. Palliative treatment for incurable malignant colorectal obstructions: a meta-analysis. World J Gastroenterol 2013; 19 (33) 5565-5574
  • 19 Abelson JS, Yeo HL, Mao J, Milsom JW, Sedrakyan A. Long-term postprocedural outcomes of palliative emergency stenting vs stoma in malignant large-bowel obstruction. JAMA Surg 2017; 152 (05) 429-435
  • 20 Fernández-Esparrach G, Bordas JM, Giráldez 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 (05) 1087-1093
  • 21 Saltz LB, Clarke S, Díaz-Rubio E. , et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol 2008; 26 (12) 2013-2019
  • 22 Grothey A, Van Cutsem E, Sobrero A. , et al; CORRECT Study Group. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet 2013; 381 (9863): 303-312
  • 23 Yoshida S, Isayama H, Koike K. Palliative self-expandable metallic stent placement for colorectal obstruction caused by an extracolonic malignancy. Gastrointest Interv 2014; 3: 75-79
  • 24 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 (04) 713-720
  • 25 Frager D, Rovno HD, Baer JW, Bashist B, Friedman M. Prospective evaluation of colonic obstruction with computed tomography. Abdom Imaging 1998; 23 (02) 141-146
  • 26 Laasch HU. Current designs of self-expanding stents. In: Kozarek RA, Baron TH, Song HY. , eds. Self-Expandable Stents in the Gastrointestinal Tract. New York: Springer; 2013: 51-69
  • 27 García-Cano J. Colonic self-expandable metal stents: indications and placement techniques. In: Kozarek RA, Baron TH, Song HY. , eds. Self-Expandable Stents in the Gastrointestinal Tract. New York: Springer; 2013: 175-189
  • 28 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 (05) 448-454
  • 29 Inaba Y, Arai Y, Yamaura H. , et al; Japan Interventional Radiology in Oncology Study Group. Phase II clinical study on stent therapy for unresectable malignant colorectal obstruction (JIVROSG-0206). Am J Clin Oncol 2012; 35 (01) 73-76
  • 30 Zhang Y, Shi J, Shi B, Song CY, Xie WF, Chen YX. 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 (07) e367-e374
  • 31 Yang Z, Wu Q, Wang F, Ye X, Qi X, Fan D. 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 (07) 825-835
  • 32 Kim EJ, Kim YJ. Stents for colorectal obstruction: past, present, and future. World J Gastroenterol 2016; 22 (02) 842-852
  • 33 Yoon JY, Jung YS, Hong SP, Kim TI, Kim WH, Cheon JH. Clinical outcomes and risk factors for technical and clinical failures of self-expandable metal stent insertion for malignant colorectal obstruction. Gastrointest Endosc 2011; 74 (04) 858-868
  • 34 Meisner S, González-Huix F, Vandervoort JG. , et al; WallFlex Colonic Registry Group. 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 (04) 876-884
  • 35 Baron TH, Wong Kee Song LM, Repici A. Role of self-expandable stents for patients with colon cancer (with videos). Gastrointest Endosc 2012; 75 (03) 653-662
  • 36 Janík V, Horák L, Hnaníček J, Málek J, Laasch HU. Biodegradable polydioxanone stents: a new option for therapy-resistant anastomotic strictures of the colon. Eur Radiol 2011; 21 (09) 1956-1961
  • 37 Repici A, Pagano N, Rando G. , et al. A retrospective analysis of early and late outcome of biodegradable stent placement in the management of refractory anastomotic colorectal strictures. Surg Endosc 2013; 27 (07) 2487-2491
  • 38 Kim EY, Song HY, Kim JH. , et al. IN-1233-eluting covered metallic stent to prevent hyperplasia: experimental study in a rabbit esophageal model. Radiology 2013; 267 (02) 396-404
  • 39 Li G, Chen Y, Hu J. , et al. A 5-fluorouracil-loaded polydioxanone weft-knitted stent for the treatment of colorectal cancer. Biomaterials 2013; 34 (37) 9451-9461