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%.
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.
- Thompson MR, O’Leary DP, Flashman K, Asiimwe A, Ellis BG, Senapati A. Clinical assessment to determine the risk of bowel cancer using Symptoms, Age, Mass and Iron Deficiency Anemia (SAMI). Br J Surg. 2017;104(10):1393-404.
- Markogiannakis H, Messaris E, Dardamanis D, et al. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol. 2007;13(3):432-7.
- Aslar AK, Ozdemir S, Mahmoudi H, Kuzu MA. Analysis of 230 cases of emergent surgery for obstructing colon cancer-lessons learned. J Gastrointest Surg. 2011;15(1):110-9.
- Baron TH, Wong Kee Song LM, Repici A. Role of self-expandable stents for patients with colon cancer (with videos). Gastrointest Endosc. 2012;75(3):653-62.
- Watt AM, Faragher IG, Griffin TT, et al. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg. 2007;246(1):24-30.
- 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):2051-7.
- van Halsema EE, van Hooft JE, Small AJ, et al. Perforation in colorectal stenting: a meta-analysis and search for risk factors. Gastrointest Endosc. 2014;79(6):970-82.e7.
- Van Hooft JE, van Halsema EE, Vanbiervliet G, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2014;46(11):990-1053.
- 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(3):560-72. doi: 10.1016/j.gie.2009.10.012