Place of colorectal stents in therapeutic management of malignant large bowel obstructions

Placement of a colonic stenta) Pre-treatment assessmentb) Time limit for stent placementc) Endoscopic or radiological placement?d) Environment and conditioning of thepatiente Spcific equipment and endoscopef) Stent plaement proceureg) Stentsh) Particular situations and locationsi) Tehnical contraindicationsC. Success and complications ofcolonicstenta) Short-term outcomesb) Long-term outcomes. Surgical treatmentE. Colonic stent with curative intet,as a bridge to surgery F. Colonic stent with palliatve intentG. Colonic stent and anti-angiogenictreatmentTke home messages:? Whatever the situation a medical-suricaldiscussion must take place beforeany treatment deciion.The placement of a stent is not recommendedthe abence of clinical andradiological signs of obstruction, venwhen the endoscope cannot passthrough the tumour.? Iindicated, colonic stenting should beconsidered within12 to 24 hours afteradmission.Stent is contraindicated n cases of perforation,clinical and/or radiologicalsigns of colonic suffering, for cancer ofthe low and middle rectum, and whencolonic obstruction is associated withsmall bowel incarceration.Stent must be placed endoscopicallyand under radiological control.Stent placement must be performed bya trained operator in a suitable medicosurgicalunit.The use of polyethylene glycol (PEG)and other oral preparations is contraindicated.Pre- expansion and passage through thetumour stenosis by a large-caliberendoscope must be avoided.In curative intent (non metastatictumour or resectable metastases),stenting cannot be recommended asfirst-line intervention. It remains atherapeutic option in expert centres,pending validation by a randomizedstudy. In the context of curative intent,the surgical treatment of occlusion ispreferred.In the context of palliative intent(unresectable metastases, unresectablepatient), stenting can be recommendedas a first-line intervention. In thissituation surgery is another treatmentoption. In patients with a colonic stent, usinganti-angiogenic therapy may causemore frequent local complications(relative contraindication), and theplacement of a stent in a patient treatedwith anti-angiogenic treatment is notrecommended.The short-term efficacy data of stentsare generally good. There are few dataabout long-term outcomes or aboutpatients receiving chemotherapy withor without targeted therapy.