The use of self-expanding metallic stents in the management of benign colonic obstruction: a systematic review and meta-analysis

Armin Fardanesh; Jayan George; Daniel Hughes; Stavroula Stavropoulou-Tatla; Pawan Mathur

doi:10.1007/s10151-024-02959-7

The use of self-expanding metallic stents in the management of benign colonic obstruction: a systematic review and meta-analysis

Tech Coloproctol. 2024 Jul 19;28(1):85. doi: 10.1007/s10151-024-02959-7.

Authors

Armin Fardanesh¹, Jayan George^{2

3}, Daniel Hughes⁴, Stavroula Stavropoulou-Tatla⁵, Pawan Mathur⁶

Affiliations

¹ Department of General Surgery, Royal London Hospital, Bart's Health NHS Foundation Trust, London, England, UK.
² Department of General Surgery, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Sheffield, England, UK. jayan.george@aol.com.
³ Division of Clinical Medicine, University of Sheffield, Sheffield, England, UK. jayan.george@aol.com.
⁴ Department of UGI Surgery, Royal Berkshire NHS Foundation Trust, Reading, England, UK.
⁵ Department of Plastic Surgery, St George's University Hospitals NHS Foundation Trust, London, England, UK.
⁶ Department of General Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, England, UK.

Abstract

Introduction: Patients presenting with large bowel obstruction (LBO) frequently undergo emergency surgery that is associated with significant morbidity. In malignant LBO, endoscopic approaches with placement is a self-expanding metal stent (SEMS), have been proposed to prevent emergency surgery and act as a bridge to an elective procedure-with the intention of avoiding a stoma and reducing morbidity. This systematic review aims to assess the quality and outcomes of data available on the use of SEMS in benign causes of colonic obstruction.

Methods: This systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the protocol was registered on Prospero (ID: CRD42021239363). PUBMED, MEDLINE, HMIC, CINAHL, AMED, EMBASE, APA and Cochrane databases were searched. Studies were assessed for quality utilising the MINORS criteria. Pooled odds ratios with 95% confidence intervals (95% CI) were calculated using random effects models.

Results: Sixteen studies were included for analysis. 300 patients were included with an average age of 68, and a male predominance of 57%. The quality of the papers included were at risk of bias. The pooled rate of technical success of procedure was 94.4% (95% CI 90.5-96.8%) The pooled rate of clinical success was 77.6% (95% CI: 66.6-85.7%). Adverse effects were low, with perforation 8.8% (4.5-16.6%), recurrence 26.5% (17.2-38.5%) and stent migration 22.5% (14.1-33.8%).

Discussion: This systematic review demonstrated that SEMS for benign colonic obstruction can be a safe and successful procedure. The utilisation of SEMS in malignant disease as a bridge to surgery has been well documented. Whilst the limitations of the data interpreted are appreciated, we postulate that SEMS could be utilised to decompress patients acutely and allow pre-operative optimisation, leading to a more elective surgery with less subsequent morbidity.

Keywords: Benign; Benign colonic obstruction; Large bowel obstruction; Meta-analysis; Self-expanding metal stents; Stenting.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Aged
Colonic Diseases* / etiology
Colonic Diseases* / surgery
Female
Humans
Intestinal Obstruction* / etiology
Intestinal Obstruction* / surgery
Male
Middle Aged
Self Expandable Metallic Stents*
Treatment Outcome