Prevention & Rescue for Colorectal Stent Re-stenosis

Self-expandable metal stents (SEMSs) have been regarded as an alternative treatment for palliation of malignant colorectal obstruction. Since the first colonic stent placement was introduced in 1991 by Dohmoto, a lot of studies have demonstrated that SEMSs is a safe and effective therapy for palliation with better clinical outcomes and lower mortality than emergency surgery. With the advance in stenting techniques and devices, recent studies reported the technical and clinical success rates of SEMSs up to 90%. In the practice, SEMS is performed as for the palliative aim or bridge to surgery. Previous our study showed 95.8% of early success rate and favorable long-term patency for the palliative purpose. Furthermore, SEMS placement had positive outcomes, including shorter hospital stay, earlier administration of chemotherapy, and a lower rate of stoma formation than emergent surgery. As for bridge to surgery, SEMS insertion provides a safe single-stage surgical resection with higher primary anastomosis rates than emergent surgery in patients with resectable colorectal cancers (CRCs). Therefore, placement of SEMSs has been generally accepted as an initial treatment of malignant colorectal obstruction. However, SEMS develops complications. A meta-analysis showed that re-obstruction rates were 12% (range, 1%-92%), migration 11% (range, 0%-50%), and perforation 4.5% (range, 1%-92%). Because of the modern polychemotherapy combined with targeted agents, the survival of patients with unresectable CRCs has been lengthening from 11-13 months to 14.8-21.5 months. Therefore, there has an increasing chance to develop re-obstruction in patients with CRCs after successful stenting. This issue covers the preventive and rescue therapy for re-stenosis of SEMS in patients with CRCs.