Elsevier

Gastrointestinal Endoscopy

Volume 80, Issue 5, November 2014, Pages 747-761.e75
Gastrointestinal Endoscopy

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

https://doi.org/10.1016/j.gie.2014.09.018Get rights and content

Section snippets

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

Methods

The ESGE commissioned this Guideline (chairs C.H. and J.-M.D.) and appointed a guideline leader (J.v.H.) who invited the listed authors to participate in the project development. The key questions were prepared by the coordinating team (E.v.H. and J.v.H.) and then approved by the other members. The coordinating team formed task force subgroups, each with its own leader, and divided the key topics among these task forces (see Appendix e1, available online at www.giejournal.org).

Each task force

Recommendations and statements

Evidence statements and recommendations are stated in bold italics.

General considerations before stent placement (Table e1, available online at www.giejournal.org)

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).

Colonic stenting is indicated only in those patients with both

References (128)

  • H. Kim 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)
  • M.A. de Gregorio et al.

    Ten-year retrospective study of treatment of malignant colonic obstructions with self-expandable stents

    J Vasc Interv Radiol

    (2011)
  • A. Tanaka et al.

    Endoscopic balloon dilation for obstructive colorectal cancer: a basic study on morphologic and pathologic features associated with perforation

    Gastrointest Endosc

    (2010)
  • E.E. van Halsema et al.

    Perforation in colorectal stenting: a meta-analysis and a search for risk factors

    Gastrointest Endosc

    (2014)
  • T.H. Baron et al.

    Role of self-expandable stents for patients with colon cancer (with videos)

    Gastrointest Endosc

    (2012)
  • A.J. Small et al.

    Comparison of Wallstent and Ultraflex stents for palliation of malignant left-sided colon obstruction: a retrospective, case-matched analysis

    Gastrointest Endosc

    (2008)
  • J. Garcia-Cano et al.

    Use of self-expanding metal stents to treat malignant colorectal obstruction in general endoscopic practice (with videos)

    Gastrointest Endosc

    (2006)
  • A. Repici et al.

    Stenting of the proximal colon in patients with malignant large bowel obstruction: techniques and outcomes

    Gastrointest Endosc

    (2007)
  • A. Gainant

    Emergency management of acute colonic cancer obstruction

    J Visc Surg

    (2012)
  • M. Cuffy et al.

    Colorectal cancer presenting as surgical emergencies

    Surg Oncol

    (2004)
  • B.K. Kim 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)
  • J.H. Kim et al.

    Metallic stent placement in the palliative treatment of malignant colonic obstructions: primary colonic versus extracolonic malignancies

    J Vasc Interv Radiol

    (2011)
  • R.N. Keswani et al.

    Stenting for malignant colonic obstruction: a comparison of efficacy and complications in colonic versus extracolonic malignancy

    Gastrointest Endosc

    (2009)
  • X. Huang et al.

    Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis

    J Gastrointest Surg

    (2014)
  • R. Cirocchi 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)
  • A. De Ceglie 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)
  • A.H. Ghazal 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)
  • A. Jemal et al.

    Global cancer statistics

    CA Cancer J Clin

    (2011)
  • M. Winner et al.

    Incidence and predictors of bowel obstruction in elderly patients with stage IV colon cancer: a population-based cohort study

    JAMA Surg

    (2013)
  • E. Jullumstro et al.

    Colon cancer incidence, presentation, treatment and outcomes over 25 years

    Colorectal Dis

    (2011)
  • N. Cheynel et al.

    Trends in frequency and management of obstructing colorectal cancers in a well-defined population

    Dis Colon Rectum

    (2007)
  • E. Fiori et al.

    Palliative management of malignant rectosigmoidal obstruction. Colostomy vs. endoscopic stenting: a randomized prospective trial

    Anticancer Res

    (2004)
  • J.M. Dumonceau et al.

    European Society of Gastrointestinal Endoscopy (ESGE) Guideline Development Policy

    Endoscopy

    (2012)
  • J.H. Kim et al.

    The efficacy of self-expanding metal stents for malignant colorectal obstruction by noncolonic malignancy with peritoneal carcinomatosis

    Dis Colon Rectum

    (2013)
  • S. Abbott et al.

    Predictors of outcome in palliative colonic stent placement for malignant obstruction

    Br J Surg

    (2014)
  • J.H. Choi et al.

    Covered self-expandable metal stents are more associated with complications in the management of malignant colorectal obstruction

    Surg Endosc

    (2013)
  • F. Donnellan et al.

    Efficacy and safety of colonic stenting for malignant disease in the elderly

    Int J Colorectal Dis

    (2010)
  • J. Geraghty et al.

    Management of large bowel obstruction with self-expanding metal stents: a multicentre retrospective study of factors determining outcome

    Colorectal Dis

    (2014)
  • S. Biondo et al.

    Large bowel obstruction: predictive factors for postoperative mortality

    Dis Colon Rectum

    (2004)
  • P.P. Tekkis et al.

    The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer

    Ann Surg

    (2004)
  • D. Frager et al.

    Prospective evaluation of colonic obstruction with computed tomography

    Abdom Imaging

    (1998)
  • K. Kodeda et al.

    Population-based data from the Swedish Colon Cancer Registry

    Br J Surg

    (2013)
  • M. Latournerie et al.

    Epidemiology and prognosis of synchronous colorectal cancers

    Br J Surg

    (2008)
  • V. Papadopoulos et al.

    Synchronous and metachronous colorectal carcinoma

    Tech Coloproctol

    (2004)
  • S.H. Park et al.

    CT colonography for detection and characterisation of synchronous proximal colonic lesions in patients with stenosing colorectal cancer

    Gut

    (2012)
  • E.Y. Cha et al.

    CT colonography after metallic stent placement for acute malignant colonic obstruction

    Radiology

    (2010)
  • S.G. Lim 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)
  • K. Nagata et al.

    PET/CT colonography for the preoperative evaluation of the colon proximal to the obstructive colorectal cancer

    Dis Colon Rectum

    (2008)
  • I.A. Pirlet et al.

    Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial

    Surg Endosc

    (2011)
  • V.F. Sai et al.

    Colonoscopy after CT diagnosis of diverticulitis to exclude colon cancer: a systematic literature review

    Radiology

    (2012)

    • Cited by (0)

    DISCLOSURES: J.E. van Hooft: consultancy work for Cook Medical, Boston Scientific, Abbott, and Covidien. J.M. Dewitt: consultant for Boston Scientific, Olympus America, and Apollo Endosurgery without grant nor honoria. S. Meisner: consultancy work for Coloplast Denmark, Olympus Denmark, Olympus Europa, and Boston Scientific. V. Muthusami: consultant for Boston Scientific. A. Repici received a consulting fee and speech fee from Boston Scientific and research grants from Fujifilm, Covidien GI Solutions, and Merit Medical. G. Webster: Advisory Board for Cook Medical and Boston Scientific. All other authors disclosed no financial relationships relevant to this publication.

    View full text
    Copyright © 2014 American Society for Gastrointestinal Endoscopy and the European Society of Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.