title: Current management of acute malignant large bowel obstruction: a systematic review.
abstract: BACKGROUND
  The management of colonic obstruction has changed in recent years. In distal obstruction, optimal treatment remains controversial, particularly after the appearance and use of colonic endoluminal stents. The purpose of this study was to review the current treatment of acute malignant large bowel obstruction according to the level of evidence of the available literature.
  
  
  METHODS
  A systematic search was conducted in PubMed, MEDLINE, Embase, and Google Scholar for articles published through January 2013 to identify studies of large bowel obstruction and colorectal cancer. Included studies were randomized and nonrandomized controlled trials, reviews, systematic reviews, and meta-analysis.
  
  
  RESULTS
  After a literature search of 1,768 titles and abstracts, 218 were selected for full-text assessment; 59 studies were ultimately included. Twenty-five studies of the diagnosis and treatment of obstruction and 34 studies of the use of stents were assessed.
  
  
  CONCLUSIONS
  In view of the various alternatives and the lack of high-grade evidence, the treatment of distal colonic obstruction should be individually tailored to each patient.
authors.affiliation: Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, and IDIBELL, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Frago
authors.affiliation: Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, and IDIBELL, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Ramirez
authors.affiliation: Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, and IDIBELL, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Monica
authors.initials: M
authors.lastname: Millan
authors.affiliation: Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, and IDIBELL, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Kreisler
authors.affiliation: Department of Surgery, Colorectal Unit, Gregorio Marañon General University Hospital, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: del Valle
authors.affiliation: Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, and IDIBELL, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain. Electronic address: sbn.biondo@gmail.com.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Biondo
mesh_terms: D000208:Acute Disease; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology; D002986:Clinical Trials as Topic; D003082:Colectomy; D012809:Colon, Sigmoid / Q000601:surgery; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D003125:Colostomy; D003287:Contrast Media; D004733:Enema; D019317:Evidence-Based Medicine; D006801:Humans; D007082:Ileum / Q000601:surgery; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D010535:Laparoscopy; D010166:Palliative Care / Q000379:methods; D057285:Precision Medicine; D012007:Rectum / Q000601:surgery; D015607:Stents; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media
keywords: Colonic stent; Malignant large bowel obstruction; Surgical treatment; Systematic review