In the United States, uncovered self-expanding metal stents (SEMS) are typically used in obstructing CRC.4 The vast majority of CRC stenting cases are for left-sided lesions, as proximal lesions are more challenging and carry a higher risk of migration. A large systematic review noted a median technical success rate (defined as passing of a guidewire and appropriate placement of the stent) of about 96%.5 Clinical success was more difficult to normalize between all of the included studies, but was reported at a median rate of 92%.

In patients who underwent stenting for palliation, the median patency duration was 106 days. The median rate of re-intervention in these patients was 20%. Patients who received stenting as a bridge to surgery had a median time to surgery of 7 days and a median rate of re-intervention of only 7%. The median complication rates were stent migration in 11%, perforation in 4.5%, and re-obstruction in 12%.5

Another systematic review found similar rates of technical (94%) and clinical success (91%), though clinical success decreased to 72% when the indication was a bridge to surgery.6 Complication rates were also similar: stent migration in 12%, perforation in 4%, and re-obstruction in 7.3%.


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Colonic stenting may be a contraindication in patients who are completely obstructed, have an intra-abdominal abscess, or have evidence of colonic ischemia and/or perforation.7,8 There are also data to support avoiding colonic stenting in patients receiving bevacizumab, as this drug carries an increased risk of perforation.8,9

Once a colonic stent is placed, patients must follow a special diet to avoid obstructing the stent itself. Patients should follow a low-residue/low-fiber diet and keep their stools soft with polyethylene glycol (if needed).

Colonic stents can also migrate, which may cause obstructive symptoms, abdominal pain and/or distension, or rectal bleeding. Patients should be aware of these possible complications and alert their physicians immediately if there is evidence of any of them.

References

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