Covered or uncovered stents in the colon?

摘要

Insertion of self-expandable metal stents (SEMSs) to manage colorectal obstruction has been adopted in most tertiary endoscopic centers, and several brands of colonic SEMSs are available.1 The main indications for colonic stenting are (1) preoperative colonic decompression before colonic resection and (2) palliation of malignant colorectal obstruction.For patients presenting with acute left-sided colonic obstruction secondary to an operable malignancy, SEMS placement allows colonic decompression, preoperative bowel preparation, and preoperative colonoscopy to assess for synchronous cancers. Patients may then undergo a 1-stage surgical procedure, possibly laparoscopically, with a primary anastomosis. Whether this approach is superior to surgical decompression and a 2-stage surgical procedure is not yet known, and a randomized trial designed to compare the effectiveness and cost of these 2 strategies is under way.2 A pooled analysis of previously published studies reflecting 407 patients undergoing colorectal SEMS insertion as a bridge to surgery revealed a technical success rate of 92%.3 Of those patients with successful SEMS placement, 78% underwent a 1-stage surgical procedure with primary anastomosis. Furthermore, decision analysis suggests that preoperative colonic SEMS placement is less costly than emergent surgical resection and resulted in fewer deaths, surgical procedures, and stoma requirements.