The role of stents in the management of colorectal complications: a systematic review

Arezzo, Alberto; Bini, Roberto; Secco, Giacomo Lo; Verra, M.; Passera, Roberto

doi:10.1007/s00464-016-5315-x

Cited by 22 publications

(13 citation statements)

References 36 publications

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“…Stents can vary in terms of their silicon coverage (fully, partially, uncovered) and material (metal or biodegradable). The aim with anastomotic leak is to place the stent across the defect to prevent communication between the lumen and extraluminal space to protect the patient from sepsis during tissue growth [ 16 ].…”

Section: Resultsmentioning

confidence: 99%

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Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

et al. 2019

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BackgroundAnastomotic complications following colorectal surgery are associated with significant morbidity and mortality. For patients in whom systemic sepsis is absent or well controlled, minimal access techniques, such as endoscopic therapies, are being increasingly employed to reduce the morbidity of surgical re-intervention. In this review, we aim to assess the utility of endoscopic management in the acute setting of colorectal anastomotic complications, focusing on anastomotic leak.MethodA literature search was performed for published full text articles using the PubMed, Cochrane and Scopus databases using the search criteria string “colorectal anastomotic (“leak” OR “bleed”), “endoscopy”, endoscopic management”. Additional papers were detected by scanning the references of relevant papers. Data were extracted from each study by two authors onto a dedicated pro-forma. Given the nature of the data extracted, no meta-analysis was performed.ResultsA total of 89 papers were identified, 16 of which were included in this review; an additional 14 papers were obtained from reference searches. In patients who are not physiologically compromised, there are promising data regarding the salvage rate of stents, over-the-scope endoscopic clips, vacuum therapy and fibrin glue in the early management of colorectal anastomotic leak. There is no consensus regarding the optimal approach, and data to assist the physician in patient selection are lacking. Whilst data on salvage (i.e. healing and avoidance of surgery) are well understood, no data on functional outcomes are reported.ConclusionEndoscopic therapy in the management of stable patients with colorectal anastomotic leaks appears safe and in selected patients is associated with high rates of technical success. Challenges remain in selecting the most appropriate strategy, patient selection, and understanding the functional and long-term sequelae of this approach. Further evidence from large prospective cohort studies are needed to further evaluate the role of these novel strategies.

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Section: Resultsmentioning

confidence: 99%

“…A systematic review of the use of stents for colorectal anastomotic complications including was published by Arezzo et al in 2017 [ 16 ]. Thirty-two studies were included (one multi-centre study) including 223 patients.…”

Section: Resultsmentioning

confidence: 99%

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

et al. 2019

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“…Converting emergency surgery to elective surgery resulted in a more meticulous evaluation and treatment, as shown by the better shortterm results [55]. At the same time, however, stent mechanical stress might cause long-term effects on tumour cell spreading; therefore, the debate on BTS persists [15,19,24,34,35,56]. Related studies have shown that mechanical friction of the colonoscope and guidewire, mechanical expansion after stent release, and stent-related perforation during stenting can lead to the localised spreading of tumour cells and dissemination through blood and lymphatic vessels [57,58].…”

Section: Discussionmentioning

confidence: 99%

“…The reasons for exclusion were as follows: article content [23][24][25][26] (n = 4), no comparison study [27][28][29][30] (n = 5), non-English language (n = 1), and insufficient follow-up time (n = 1). A total of 24 articles were included in the study, including 5 randomised controlled trials [31][32][33][34][35], 16 retrospective studies [18,19,[36][37][38][39][40][41][42][43][44][45][46][47][48][49], and 3 prospective studies [17,50,51] (Fig. 1).…”

Section: Research Characteristicsmentioning

confidence: 99%

Long-term tumour outcomes of self-expanding metal stents as ‘bridge to surgery’ for the treatment of colorectal cancer with malignant obstruction: a systematic review and meta-analysis

Cao

Deng

et al. 2019

Int J Colorectal Dis

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Purpose To explore the long-term oncological results of self-expanding metal stents (SEMS) as a surgical transition compared with those of simple emergency surgery. Methods A systematic review of studies involving long-term tumour outcomes comparing SEMS with emergency surgery was conducted. All studies included information on 3-year and 5-year survival rates, 3-year and 5-year disease-free survival (DFS) rates, and local and overall recurrence rates; the results were expressed as odds ratios. Results Overall, 24 articles and 2508 patients were included, including 5 randomised controlled trials, 3 prospective studies, and 16 retrospective studies. The 3-year survival rate (odds ratio (OR) = 0.88, 95% confidence interval (CI) 0.69-1.12, P = 0.05), 5-year survival rate (OR = 0.91, 95% CI 0.70-1.17, P = 0.67), 3-year DFS rate (OR = 1.14, 95% CI 0.91-1.42, P = 0.65), 5-year DFS rate (OR = 1.35, 95% CI 0.91-2.02, P = 0.17), overall recurrence rate (OR 1.04, 95% CI 0.77-1.41, P = 0.14), and local recurrence rate (OR 1.37, 95% CI 0.84-2.23, P = 0.92) were determined. There was no significant difference between the randomised and observational studies in the subgroup analysis, and the 5-year survival rate was higher in studies with a stent placement success rate of ≥ 95%. Conclusion SEMS implantation was a viable alternative in malignant left colon obstruction as a transition to surgery; its longterm survival results, including 5-year DFS and overall survival, were equivalent to those of emergent surgery.

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“…The clinical use of SEMS in lower GI tract: The role of SEMS has been investigated even in the management of colorectal leaks and fistulae. A meta-analysis considering 17 studies including 68 patients treated with SEMS showed a success rate in approximately 75% of cases[ 59 ]. A case series considering 22 patients treated for anastomotic leakage (at least 30% of circumference) reported a healing rate with diverting stoma reversal of 84%[ 60 ].…”

Section: Luminal Stentmentioning

confidence: 99%

Endoscopic management of gastrointestinal leaks and fistulae: What option do we have?

Cereatti

Grassia

Drago

et al. 2020

WJG

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Gastrointestinal leaks and fistulae are serious, potentially life threatening conditions that may occur with a wide variety of clinical presentations. Leaks are mostly related to post-operative anastomotic defects and are responsible for an important share of surgical morbidity and mortality. Chronic leaks and long standing post-operative collections may evolve in a fistula between two epithelialized structures. Endoscopy has earned a pivotal role in the management of gastrointestinal defects both as first line and as rescue treatment. Endotherapy is a minimally invasive, effective approach with lower morbidity and mortality compared to revisional surgery. Clips and luminal stents are the pioneer of gastrointestinal (GI) defect endotherapy, whereas innovative endoscopic closure devices and techniques, such as endoscopic internal drainage, suturing system and vacuum therapy, has broadened the indications of endoscopy for the management of GI wall defect. Although several endoscopic options are currently used, a standardized evidence-based algorithm for management of GI defect is not available. Successful management of gastrointestinal leaks and fistulae requires a tailored and multidisciplinary approach based on clinical presentation, defect features (size, location and onset time), local expertise and the availability of devices. In this review, we analyze different endoscopic approaches, which we selected on the basis of the available literature and our own experience. Then, we evaluate the overall efficacy and procedural-specific strengths and weaknesses of each approach.

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The role of stents in the management of colorectal complications: a systematic review

Cited by 22 publications

References 36 publications

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

Long-term tumour outcomes of self-expanding metal stents as ‘bridge to surgery’ for the treatment of colorectal cancer with malignant obstruction: a systematic review and meta-analysis

Endoscopic management of gastrointestinal leaks and fistulae: What option do we have?

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