Current status of colonic stent for obstructive colorectal cancer in Japan; a review of the literature

Abstract

Colorectal cancer is the most common cancer in Japan. Approximately 10%-20% of the patients with colorectal cancer present with large bowel obstruction, and those who present with malignant colonic obstruction (MCO) require urgent decompression because MCO can cause electrolytic fluid imbalance, colonic necrosis, bacterial translocation, and death. Placement of colonic stents (self-expandable metallic stents) for MCO is a major and standard endoscopic treatment that has been available since 2012 in Japan. This review presents the current conditions and future prospects of this procedure based on the literature. The current indication of colonic stent placement is malignant colorectal stenosis. One of the purposes of using stents is palliative treatment; further, its advantages over emergency surgery with colostomy include avoidance of colostomy, relief of obstruction, shorter hospitalization, and better quality of life. In addition, stent placement can also be used as a bridge to surgery since the duration of the hospitalization is shorter and postoperative complications, colostomy rates, and mortality rates are lower with elective than with emergency surgery. Although recent studies have reported low complication rates related to colonic stents, complications may still occur, highlighting the importance of good preparation, adequate staffing, backup systems, and informed consent. The current major problem related to colonic stents is the lack of evidence on patients' long-term prognoses for bridge to surgery purposes, awaiting the results of ongoing clinical research.

The number of obstructive colorectal cancers in Japan has increased during the COVID-19 pandemic: A retrospective single-center cohort study

“…Almost all of the emergency admissions for CRC patients during the observation periods were due to a bowel obstruction which required decompression procedures. The reported incidence of obstructive CRCs requiring decompression procedures is 10%–20% [ 19 , 20 ], which is compatible with the incidence of CRCs with complete obstruction before the state of emergency in our present investigation. However, we observed that the incidence of obstructive CRCs requiring decompression significantly increased to 39% during the COVID-19 pandemic.…”

Self-Expanding Metal Stent Insertion by Colorectal Surgeons Using a Two-Person Approach Colonoscopy Without Fluoroscopic Monitoring in the Management of Acute Colorectal Obstruction: A 14-Year Experience

“…The clinical advantages of SEMS insertion in the management of ACO combined with the little negative oncological consequences makes stent a effective clinical method [4] . The limitation of the use of SEMS is the high perforation rate in several randomised controlled trials [24,33,34] , other complications, technical and clinical success rate need to improve for some units, long term exposure under X-ray environmental threats health to operators, especially young doctor [1] et al The variation in the rates of success of SEMS insertion and associated complications reported in the literature suggests that individual expertise institutional experience and available resources [26] has a signi cant bearing on the clinical application of SEMS.…”

“…These remaining patients with ACO were included in this study. The signs of obstruction were de ned as (1) distended proximal bowel, liquid surface, transitional zone or collapsed distal bowel on abdominal CT scans ( Fig. 1), which can also demonstrate the level of obstruction position and length of the stricture; or (2) in the colonoscopic evaluation, it is impossible to pass through the stenotic area.…”

Comparison of the Oncological Outcomes of Stenting as a Bridge to Surgery and Surgery Alone in Stages II-III Obstructive Colorectal Cancer; A Retrospective Study

“…The CROSS system was developed in 2012 by the Japan Colonic Stent Safe Procedure Research Group as a generally applicable technique for the assessment of colonic obstruction and stenosis; the CROSS system is published on the Research Group's home page (http://colon-stent.com/: Table 1). The colonic stents used in BTS for patients with CROSS scores between 0 and 1, and those used for palliative reasons in patients with scores between 0 and 3 are indicated appropriately [15]. At our institute, the indications for stent placement in each case of obstructive colorectal cancer were nally decided based on the CROSS scores, but the decisions were made not by surgeons but by gastroenterologists.…”