Endoscopic Management of Malignant Colorectal Strictures

A self-expandable metal stent (SEMS) can be used to decompress dilated bowel proximal to a malignant stricture, either in the palliative setting or as a bridge to potentially curative oncological resection. Colonic strictures can also be caused by extracolonic malignancy. Whatever the primary cause of obstruction, several considerations need to be made before, during, and after the stent placement procedure. An abdominal CT scan is mandatory to assess the severity of the bowel distention, localize the obstruction, assess the severity, length, and angulation of the stenosis, and look for contraindications for colonic stenting such as bowel perforation or multilevel obstructions. Incomplete obstructions could be carefully treated with oral laxatives and enemas. In other cases, endoscopic stent placement should be considered with distal preparation only. Endoscopy will reveal additional information about the nature and accessibility of the obstruction. If the endoscopy can be passed through the obstruction, it is safe not to place a stent and continue laxation. In addition, experience with colonic stenting and simultaneous treatment with chemotherapy ± anti-angiogenic treatment are important factors to take into account beforehand. Finally, expectations regarding clinical relief and potential adverse events need to be known and discussed with the patient. In the current chapter, practical considerations regarding colonic stent placement are discussed, based on expert opinion and literature review.