Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis
Background/Aims Self-expanding metallic stents (SEMS) are an alternative to emergency surgery (ES) for malignant colorectal obstruction. This study aimed to compare surgical outcomes between SEMS as a bridge to surgery (BTS) and ES in patients with malignant colorectal obstruction. Methods A compreh...
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| Format: | Article |
| Language: | English |
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Korean Society of Gastrointestinal Endoscopy
2025-03-01
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| Series: | Clinical Endoscopy |
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| Online Access: | http://e-ce.org/upload/pdf/ce-2024-120.pdf |
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| author | Sheza Malik Priyadarshini Loganathan Hajra Khan Abul Hasan Shadali Pradeep Yarra Saurabh Chandan Babu P. Mohan Douglas G. Adler Shivangi Kothari |
| author_facet | Sheza Malik Priyadarshini Loganathan Hajra Khan Abul Hasan Shadali Pradeep Yarra Saurabh Chandan Babu P. Mohan Douglas G. Adler Shivangi Kothari |
| author_sort | Sheza Malik |
| collection | DOAJ |
| description | Background/Aims Self-expanding metallic stents (SEMS) are an alternative to emergency surgery (ES) for malignant colorectal obstruction. This study aimed to compare surgical outcomes between SEMS as a bridge to surgery (BTS) and ES in patients with malignant colorectal obstruction. Methods A comprehensive database search was conducted until October 2023 to compare outcomes between SEMS as a BTS and ES. A subgroup analysis of results by malignancy site was performed. Results We analyzed 57 studies, including 7,223 patients over a mean duration of 35.4 months. SEMS as a BTS showed clinical and technical success rates of 88.0% (95% confidence interval [CI], 86.1%–90.1%; I2=68%) and 91.6% (95% CI, 89.7%–93.7%; I2=66%), respectively. SEMS as a BTS revealed reduced postoperative adverse events (odds ratio [OR], 0.51; 95% CI, 0.41–0.63; I2=70%; p<0.001) and 30-day mortality (OR, 0.52; 95% CI, 0.37–0.72; I2=10%; p<0.001) compared to ES. Subgroup analysis showed postoperative mortality of 5% and 1.5% for left- and right-sided malignancies, respectively. Adverse events were 15% and 33% for the right and left colon, respectively. Conclusions SEMS as a BTS demonstrated a higher success rate, fewer postoperative adverse events, and a reduced 30-day mortality rate than ES, supporting its use as the preferred initial intervention for right- and left-sided obstructions and indicating broader clinical adoption. |
| format | Article |
| id | doaj-art-86d23e2685d44047bb92ba5469dc7465 |
| institution | DOAJ |
| issn | 2234-2400 2234-2443 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Korean Society of Gastrointestinal Endoscopy |
| record_format | Article |
| series | Clinical Endoscopy |
| spelling | doaj-art-86d23e2685d44047bb92ba5469dc74652025-08-20T03:07:27ZengKorean Society of Gastrointestinal EndoscopyClinical Endoscopy2234-24002234-24432025-03-0158224025210.5946/ce.2024.1207945Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysisSheza Malik0Priyadarshini Loganathan1Hajra Khan2Abul Hasan Shadali3Pradeep Yarra4Saurabh Chandan5Babu P. Mohan6Douglas G. Adler7Shivangi Kothari8 Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA Department of Internal Medicine, UT Health, San Antonio, TX, USA Department of Internal Medicine, Rawalpindi Medical College, Rawalpindi, Pakistan Department of Internal Medicine, Government Kilpauk Medical College, Chennai, India Department of Gastroenterology and Hepatology, Saint Louis University, St. Louis, MO, USA Department of Gastroenterology and Hepatology, CHI Creighton Medical Center, Omaha, NE, USA Department of Gastroenterology and Hepatology, Orlando Gastroenterology PA, Orlando, FL, USA Department of Gastroenterology and Hepatology, Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, CO, USA Department of Gastroenterology and Hepatology, University of Rochester, Rochester, NY, USABackground/Aims Self-expanding metallic stents (SEMS) are an alternative to emergency surgery (ES) for malignant colorectal obstruction. This study aimed to compare surgical outcomes between SEMS as a bridge to surgery (BTS) and ES in patients with malignant colorectal obstruction. Methods A comprehensive database search was conducted until October 2023 to compare outcomes between SEMS as a BTS and ES. A subgroup analysis of results by malignancy site was performed. Results We analyzed 57 studies, including 7,223 patients over a mean duration of 35.4 months. SEMS as a BTS showed clinical and technical success rates of 88.0% (95% confidence interval [CI], 86.1%–90.1%; I2=68%) and 91.6% (95% CI, 89.7%–93.7%; I2=66%), respectively. SEMS as a BTS revealed reduced postoperative adverse events (odds ratio [OR], 0.51; 95% CI, 0.41–0.63; I2=70%; p<0.001) and 30-day mortality (OR, 0.52; 95% CI, 0.37–0.72; I2=10%; p<0.001) compared to ES. Subgroup analysis showed postoperative mortality of 5% and 1.5% for left- and right-sided malignancies, respectively. Adverse events were 15% and 33% for the right and left colon, respectively. Conclusions SEMS as a BTS demonstrated a higher success rate, fewer postoperative adverse events, and a reduced 30-day mortality rate than ES, supporting its use as the preferred initial intervention for right- and left-sided obstructions and indicating broader clinical adoption.http://e-ce.org/upload/pdf/ce-2024-120.pdfbridge to surgerycolorectal neoplasmintestinal obstructionself-expanding metallic stentstreatment outcomes |
| spellingShingle | Sheza Malik Priyadarshini Loganathan Hajra Khan Abul Hasan Shadali Pradeep Yarra Saurabh Chandan Babu P. Mohan Douglas G. Adler Shivangi Kothari Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis Clinical Endoscopy bridge to surgery colorectal neoplasm intestinal obstruction self-expanding metallic stents treatment outcomes |
| title | Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis |
| title_full | Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis |
| title_fullStr | Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis |
| title_full_unstemmed | Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis |
| title_short | Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis |
| title_sort | transforming outcomes the pivotal role of self expanding metal stents in right and left sided malignant colorectal obstructions bridge to surgery a comprehensive review and meta analysis |
| topic | bridge to surgery colorectal neoplasm intestinal obstruction self-expanding metallic stents treatment outcomes |
| url | http://e-ce.org/upload/pdf/ce-2024-120.pdf |
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