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Endoscopy 2014; 46(11): 990-1053
DOI: 10.1055/s-0034-1390700
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

Jeanin E. van Hooft
1   Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
,
Emo E. van Halsema
1   Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
,
Geoffroy Vanbiervliet
2   Centre Hospitalier Universitaire de l’Archet, Pôle digestif, Nice, France
,
Regina G. H. Beets-Tan
3   Department of Radiology, Maastricht University Medical Center, The Netherlands
,
John M. DeWitt
4   Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, United States
,
Fergal Donnellan
5   UBC Division of Gastroenterology, Vancouver General Hospital, Vancouver, Canada
,
Jean-Marc Dumonceau
6   Gedyt Endoscopy Center, Buenos Aires, Argentina
,
Robert G. T. Glynne-Jones
7   Mount Vernon Cancer Centre, Northwood, Middlesex, UK
,
Cesare Hassan
8   Digestive Endoscopy Unit, Catholic University, Rome, Italy
,
Javier Jiménez-Perez
9   Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
,
Søren Meisner
10   Endoscopy Unit, Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark
,
V. Raman Muthusamy
11   Division of Gastroenterology and Hepatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States
,
Michael C. Parker
12   Royal College of Surgeons of England, London, UK
,
Jean-Marc Regimbeau
13   Department of Digestive and Oncological Surgery, University Hospital of Amiens, France
,
Charles Sabbagh
13   Department of Digestive and Oncological Surgery, University Hospital of Amiens, France
,
Jayesh Sagar
14   Department of Colorectal Surgery, Royal Surrey County Hospital, Guildford, UK
,
Pieter J. Tanis
15   Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
,
Jo Vandervoort
16   Department of Gastroenterology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
,
George J. Webster
17   Department of Gastroenterology, University College Hospital, London, UK
,
Gianpiero Manes
18   Department of Gastroenterology and Endoscopy, Guido Salvini Hospital, Garbagnate Milanese/Rho, Milan, Italy
,
Marc A. Barthet
19   Department of Gastroenterology, Hôpital Nord, Aix Marseille Université, Marseille, France
,
Alessandro Repici
20   Digestive Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy
› Author Affiliations
Further Information

Publication History

submitted 19 August 2014

accepted after revision 25 August 2014

Publication Date:
17 October 2014 (online)

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This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). This Guideline was also reviewed and endorsed by the Governing Board of the American Society for Gastrointestinal Endoscopy (ASGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.

Main recommendations

The following recommendations should only be applied after a thorough diagnostic evaluation including a contrast-enhanced computed tomography (CT) scan.

1 Prophylactic colonic stent placement is not recommended. Colonic stenting should be reserved for patients with clinical symptoms and imaging evidence of malignant large-bowel obstruction, without signs of perforation (strong recommendation, low quality evidence).

2 Colonic self-expandable metal stent (SEMS) placement as a bridge to elective surgery is not recommended as a standard treatment of symptomatic left-sided malignant colonic obstruction (strong recommendation, high quality evidence).

3 For patients with potentially curable but obstructing left-sided colonic cancer, stent placement may be considered as an alternative to emergency surgery in those who have an increased risk of postoperative mortality, i. e. American Society of Anesthesiologists (ASA) Physical Status ≥ III and/or age > 70 years (weak recommendation, low quality evidence).

4 SEMS placement is recommended as the preferred treatment for palliation of malignant colonic obstruction (strong recommendation, high quality evidence), except in patients treated or considered for treatment with antiangiogenic drugs (e. g. bevacizumab) (strong recommendation, low quality evidence).

Appendix e1 and e2

 

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