Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 5 (4), E232-E238

Long-term Outcomes of Palliative Colonic Stenting Versus Emergency Surgery for Acute Proximal Malignant Colonic Obstruction: A Multicenter Trial


Long-term Outcomes of Palliative Colonic Stenting Versus Emergency Surgery for Acute Proximal Malignant Colonic Obstruction: A Multicenter Trial

Ali Siddiqui et al. Endosc Int Open.


Background and study aims Long-term data are limited regarding clinical outcomes of self-expanding metal stents as an alternative for surgery in the treatment of acute proximal MBO. The aim of this study was to compare the long-term outcomes of stenting to surgery for palliation in patients with incurable obstructive CRC for lesions proximal to the splenic flexure. Patients and methods Retrospective multicenter cohort study of obstructing proximal CRC patients with who underwent insertion of a SEMS (n = 69) or surgery (n = 36) from 1999 to 2014. The primary endpoint was relief of obstruction. Secondary endpoints included technical success, duration of hospital stay, early and late adverse events (AEs) and survival. Results Technical success was achieved in 62/69 (89.8 %) patients in the SEMS group and in 36 /36 (100 %) patients who underwent surgery (P = 0.09). In the SEMS group, 10 patients underwent stenting as a bridge to surgery and 59 underwent stent placement for palliation. Clinical relief was achieved in 78 % of patients with stenting and in 100 % of patients who underwent surgery (P < 0.001). Patients with SEMS had significantly less acute AEs compared to the surgery group (7.2 % vs. 30.5 %, P = 0.003). Hospital mortality for the SEMS group was 0 % compared to 5.6 % in the surgery group (P = 0.11). Patients in the SEMS group had a significantly shorter median hospital stay (4 days) as compared to the surgery group (8 days) (P < 0.01). Maintenance of decompression without the recurrence of bowel obstruction until death or last follow-up was lower in the SEMS group (73.9 %) than the surgery group (97.3 %; P = 0.003). SEMS placement was associated with higher long-term complication rates compared to surgery (21 % and 11 % P = 0.27). Late SEMS AEs included occlusion (10 %), migration (5 %), and colonic ulcer (6 %). At 120 weeks, survival in the SEMS group was 5.6 % vs. 0 % in the surgery group (P = 0.8). Conclusions Technical and clinical success associated with proximal colonic obstruction are higher with surgery when compared to SEMS, but surgery is associated with longer hospital stays and more early AEs. SEMS should be considered the initial mode of therapy in patients with acute proximal MBO and surgery should be reserved for SEMS failure, as surgery involves a high morbidity and mortality.

Conflict of interest statement

Competing interests Drs. Siddiqui and Adler are consultants for Boston Scientific.


Fig. 1
Fig. 1
Patient survival in the SEMS and Surgery group at 120 weeks. SEMS, self-expanding metal stent

Similar articles

See all similar articles

Cited by 2 PubMed Central articles


    1. Athreya S, Moss J, Urquhart G et al. Colorectal stenting for colonic obstruction: the indications, complications, effectiveness and outcome – 5 year review. Eur J Radiol. 2006;60:91–94. - PubMed
    1. Riedl S, Wiebelt H, Bergmann U et al. [Postoperative complications and fatalities in surgical therapy of colon carcinoma. Results of the German multicenter study by the Colorectal Carcinoma Study Group] Chirurg. 1995;66:597–606. - PubMed
    1. Baik S H, Kim N K, Cho H W et al. Clinical outcomes of metallic stent insertion for obstructive colorectal cancer. Hepato-Gastroenterology. 2006;53:183–187. - PubMed
    1. Baque P, Chevallier P, Karimdjee S F et al. [Colostomy vs self-expanding metallic stents: comparison of the two techniques in acute tumoral left colonic obstruction][French]Annales de Chirurgie 2004129353–358. - PubMed
    1. Baron T H, Dean P A, Yates M R et al. Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc. 1998;47:277–286. - PubMed