Eskemose Sebastian Radic, Selnes Ola, Thorndal Camilla, Hansen Lea Østergaard, Al-Najami Issam, Buchbjerg Thomas, Bjørsum-Meyer Thomas
Research Unit of Surgery, Odense University Hospital, Svendborg, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Surg Endosc. 2025 Aug 26. doi: 10.1007/s00464-025-12084-7.
The role of self-expanding metallic stents (SEMS) in colorectal obstructions caused by diverticular disease remains uncertain. We aimed to investigate the technical and clinical outcomes related to this procedure, including mortality and complications.
Peer-reviewed and published literature was identified by searching Embase (Ovid), MEDLINE (Ovid), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov the 29th of April 2025. Methodological Index for Non-randomized Studies (MINORS) instrument was used to evaluate study quality. A synthesis without meta-analysis was conducted.
Twenty-seven studies (110 patients) were included, whereof 20 were observational (101 patients) and seven were case studies (9 patients). Of the observational studies, the technical and clinical success was achieved in 92.7% and 83.5% of patients, respectively. Perforation was the most common complication in 13.2% of patients and procedure related mortality was observed in 2.7%. Migration was observed in 8.5% while reobstruction was observed in 5.9%. Bridge-to-surgery was the most common indication for SEMS, with the majority of patients undergoing colorectal surgery, of whom 56.8% avoided stoma.
SEMS in diverticular obstructions are comparable to malignant obstructions besides an increased risk of perforation. Further studies are required to elucidate the role of SEMS as a short-term bridge-to-surgery in diverticular obstructions. The main strength is the identification of inadequate literature and thereby inspiring new research. The main limitation is the high risk of bias in the included literature and the low certainty of the evidence.
自膨式金属支架（SEMS）在憩室病所致大肠梗阻中的作用仍不明确。我们旨在研究与该手术相关的技术和临床结果，包括死亡率和并发症。
通过检索Embase（Ovid）、MEDLINE（Ovid）、Scopus、Web of Science、Cochrane对照试验中央注册库和Clinicaltrials.gov，于2025年4月29日确定经过同行评审并发表的文献。采用非随机研究方法学指数（MINORS）工具评估研究质量。进行了无荟萃分析的综合分析。
纳入27项研究（110例患者），其中20项为观察性研究（101例患者），7项为病例研究（9例患者）。在观察性研究中，分别有92.7%和83.5%的患者取得了技术和临床成功。穿孔是最常见的并发症，发生率为13.2%，观察到手术相关死亡率为2.7%。观察到移位率为8.5%，再梗阻率为5.9%。搭桥手术是SEMS最常见的适应证，大多数患者接受了大肠手术，其中56.8%避免了造口。
除穿孔风险增加外，SEMS在憩室梗阻中的应用与恶性梗阻相当。需要进一步研究以阐明SEMS作为憩室梗阻短期搭桥手术的作用。主要优势在于发现了文献不足，从而激发了新的研究。主要局限性在于纳入文献存在高偏倚风险且证据确定性低。
