title: Colorectal stents: do we have enough evidence?
abstract: BACKGROUND
  The use of colonic stents has significantly evolved over the last few years. Emergency surgery for colonic obstructions is usually associated with significant mortality, morbidity and often stoma formation. Colonic stents provide an alternative way to relieve colonic obstruction, and hence avoiding the risks associated with emergency surgery. This literature review aims to summarize the important current evidence regarding colorectal stenting and show whether further evaluation of the procedure is required.
  
  
  RESULTS
  The available large number of non-randomized studies suggests that Self-Expandable-Metal-Stents (SEMS) placement for acute colonic obstruction could be considered as safe and effective alternative to surgery in experienced hands either as a bridge to surgery or as a palliative measure. This evidence has led to SEMS being widely adopted. However, randomized evidence has begun to show the defects that are inherent in the low level evidence that has so far supported SEMS use and it may be that reports of randomized controlled trials may clarify the patient population where SEMS placement is appropriate.
  
  
  CONCLUSIONS
  While we are still waiting for the outcome of the multicentre randomized controlled trials in the UK and Europe, clinicians must be aware of the current evidence limitations and apply SEMS use pragmatically.
authors.affiliation: North Tyneside General Hospital, Mr. S. Kelly's Office, Rake Lane, North Shields, NE29 8NH, UK. ahmadas@doctors.org.uk
authors.forename: Ahmad
authors.initials: A
authors.lastname: Al Samaraee
authors.forename: Iain J
authors.initials: IJ
authors.lastname: McCallum
authors.forename: Louise
authors.initials: L
authors.lastname: Kenny
authors.forename: Siddek
authors.initials: S
authors.lastname: Isreb
authors.forename: Louise
authors.initials: L
authors.lastname: Macdougall
authors.forename: Mumtaz
authors.initials: M
authors.lastname: Hayat
authors.forename: Seamus
authors.initials: S
authors.lastname: Kelly
mesh_terms: D003108:Colonic Diseases / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000150:complications; D000075202:Contraindications; D006801:Humans; D007415:Intestinal Obstruction / Q000628:therapy*; D010166:Palliative Care; D015607:Stents / Q000009:adverse effects / Q000191:economics; D014481:United States