Published online Oct 7, 2014. doi: 10.3748/wjg.v20.i37.13239
Revised: January 22, 2014
Accepted: June 12, 2014
Published online: October 7, 2014
Colorectal cancer (CRC) is the 3rd most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient’s quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may be used to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient’s condition for curative surgical intervention. An overall complication rate (major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.
Core tip: Colonic stents are of benefit both as a bridge to surgery and as definitive therapy for colorectal obstruction in a large group of patients. Careful patient selection is required. Patients should be carefully managed in conjunction with the oncologist and surgeon. Endoscopists should also be vigilant for acute and delayed complications associated with colonic stent deployment.