Role of self-expanding metal stents in patients with malignant colorectal obstruction: A systematic review and meta-analysis

AIM: To assess the safety and efficacy of self-expandable metal stents (SEMSs) for malignant colorectal obstruction. METHODS: Data regarding technical success, clinical success, and procedure related complications were collected from included studies. DerSimonian-Laird random effects model was used to generate the overall outcome. Thirty international studies with a total of 2058 patients with malignant colorectal obstruction were included. RESULTS: The technical and clinical success rates for SEMS placement were 94% (95% CI: 92-96) and 91% (95% CI: 88-93), respectively. Overall complication rate for SEMS was 23% (95% CI: 18-29). Stent migration 8% (95% CI: 6-10) and stent obstruction 8% (95% CI: 6-11) were the most common complications, followed by perforation 5% (95% CI: 4%-7%). Surgical or endoscopic re-interventions were needed in 14% (95% CI: 10-18) of patients. Endoscopic repeat stent placement was required in 8% (95% CI: 6-10), while surgical intervention was needed in 6% (95% CI: 4-8). CONCLUSION: SEMS are effective when used as palliation or bridge to surgery for malignant colorectal obstruction with high technical and clinical success. About 14% of patients require repeat endoscopic or surgical intervention for stent failure or to manage stent related complications.