Neri Benedetto, Citterio Nicolò, Schiavone Sara Concetta, Biasutto Dario, Rea Roberta, Martino Margareth, Di Matteo Francesco Maria
Therapeutic GI Endoscopy Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy.
Gastroenterology Unit, Department of Systems Medicine, University 'Tor Vergata' of Rome, 00133 Rome, Italy.
Cancers (Basel). 2025 Apr 30;17(9):1522. doi: 10.3390/cancers17091522.
Malignant bowel obstruction (MBO) is a critical complication occurring in patients with advanced malignancy. Current treatments are both surgical and non-surgical, the latter including medical, endoscopic, and percutaneous approaches. Surgery is still the treatment of choice for MBO. However, almost 50% of patients are unfit for surgery because of poor performance status. Given the high post-operative mortality rate and the frailty of MBO patients, the least invasive surgical intervention is recommended. Therefore, recent multidisciplinary recommendations have suggested considering less invasive interventions instead of palliative surgery. Medical therapy, aiming to alleviate symptoms, is usually only a part of the therapeutic strategy when managing patients with MBO. Percutaneous techniques, including both interventional radiology and endoscopic procedures, are safe and effective for symptom relief, but often do not allow oral diet resumption. Endoscopic techniques are achieving a more relevant role for MBO treatment, as supported by the widening of the indication to colonic intraluminal stenting in the latest update of the European guidelines. Current data support the use of colonic stenting as both a bridge to surgery and the definitive treatment of malignant colonic obstruction. The development of endoscopic ultrasound-guided anastomotic techniques may offer the possibility of widening its applications to endoscopic treatment of MBO, allowing stenosis to be overcome, and reestablishing the continuity of the gastrointestinal tract in small bowel obstructions as well. The introduction of new interventional endoscopic techniques and their progressive diffusion will add the possibility to adopt minimally invasive solutions to treat a critical condition such as MBO.
恶性肠梗阻（MBO）是晚期恶性肿瘤患者出现的一种严重并发症。目前的治疗方法包括手术治疗和非手术治疗，后者包括药物治疗、内镜治疗和经皮治疗。手术仍然是MBO的首选治疗方法。然而，由于身体状况较差，近50%的患者不适合手术。鉴于MBO患者术后死亡率高且身体虚弱，建议采用侵入性最小的手术干预。因此，最近的多学科建议提出考虑采用侵入性较小的干预措施而非姑息性手术。旨在缓解症状的药物治疗通常只是MBO患者治疗策略的一部分。经皮技术，包括介入放射学和内镜手术，对缓解症状安全有效，但通常不允许恢复经口饮食。内镜技术在MBO治疗中发挥着越来越重要的作用，欧洲指南的最新更新中结肠腔内支架置入术适应症的扩大就支持了这一点。目前的数据支持将结肠支架置入术用作手术的桥梁以及恶性结肠梗阻的确定性治疗方法。内镜超声引导吻合技术的发展可能为将其应用扩大到MBO的内镜治疗提供可能性，从而克服狭窄，并在小肠梗阻中重建胃肠道的连续性。新的介入性内镜技术的引入及其逐渐普及将增加采用微创解决方案治疗MBO等危急病症的可能性。
