a Digestive Endoscopy Unit, Division of Gastroenterology , Humanitas Research Hospital , Rozzano , Italy.
b Academic Department of Bioscience , Humanitas University , Rozzano , Italy.
Expert Rev Gastroenterol Hepatol. 2017 Jul;11(7):633-641. doi: 10.1080/17474124.2017.1309283. Epub 2017 Mar 24.
The use of self-expanding metal stents (SEMS) has been considered an effective and safe alternative to emergency surgery as bridge to surgery or for palliation in advanced colorectal cancer even though more recent data have raised concerns on both early and long-term outcomes when patients are treated with bridge to surgery indications. Areas covered: A comprehensive literature review of articles on endoscopic management of malignant bowel obstruction was performed. Indication, technique, outcomes, benefits and risks of these treatments in acute malignant colonic obstruction were reviewed. The clinical effectiveness and safety of SEMS in obstructive colorectal cancer, as bridge to surgery or for palliation compared to surgery, is discussed. Expert commentary: SEMS placement, when performed in tertiary level center with appropriate expertise in colorectal stenting, may have several advantages over surgery avoiding the potential for surgical morbidity in a typically frail group of patients even though these advantages are to be carefully balanced over the risk of life-threatening, stent-related complications.
使用自膨式金属支架（SEMS）已被认为是一种有效且安全的替代方法，可作为手术桥接或晚期结直肠癌的姑息治疗，尽管最近的数据对采用手术桥接指征治疗的患者的早期和长期结局提出了担忧。
对有关内镜治疗恶性肠梗阻的文章进行了全面的文献回顾。回顾了这些治疗方法在急性恶性结肠梗阻中的适应证、技术、结果、益处和风险。讨论了 SEMS 在梗阻性结直肠癌中的临床效果和安全性，包括作为手术桥接或姑息治疗与手术相比的优缺点。
在具有结直肠支架适当专业知识的三级中心进行 SEMS 放置，与手术相比可能具有多种优势，可以避免潜在的手术发病率，因为这些优势需要在危及生命的支架相关并发症风险方面进行仔细权衡。对于通常身体虚弱的患者群体而言。
