title: Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.
abstract: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). This Guideline was also reviewed and endorsed by the Governing Board of the American Society for Gastrointestinal Endoscopy (ASGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations The following recommendations should only be applied after a thorough diagnostic evaluation including a contrast-enhanced computed tomography (CT) scan. 1 Prophylactic colonic stent placement is not recommended. Colonic stenting should be reserved for patients with clinical symptoms and imaging evidence of malignant large-bowel obstruction, without signs of perforation (strong recommendation, low quality evidence). 2 Colonic self-expandable metal stent (SEMS) placement as a bridge to elective surgery is not recommended as a standard treatment of symptomatic left-sided malignant colonic obstruction (strong recommendation, high quality evidence). 3 For patients with potentially curable but obstructing left-sided colonic cancer, stent placement may be considered as an alternative to emergency surgery in those who have an increased risk of postoperative mortality, I. e. American Society of Anesthesiologists (ASA) Physical Status ≥ III and/or age > 70 years (weak recommendation, low quality evidence). 4 SEMS placement is recommended as the preferred treatment for palliation of malignant colonic obstruction (strong recommendation, high quality evidence), except in patients treated or considered for treatment with antiangiogenic drugs (e. g. bevacizumab) (strong recommendation, low quality evidence).
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jeanin E
authors.initials: JE
authors.lastname: van Hooft
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Emo E
authors.initials: EE
authors.lastname: van Halsema
authors.affiliation: Centre Hospitalier Universitaire de l'Archet, Pôle digestif, Nice, France.
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Vanbiervliet
authors.affiliation: Department of Radiology, Maastricht University Medical Center, The Netherlands.
authors.forename: Regina G H
authors.initials: RG
authors.lastname: Beets-Tan
authors.affiliation: Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, United States.
authors.forename: John M
authors.initials: JM
authors.lastname: DeWitt
authors.affiliation: UBC Division of Gastroenterology, Vancouver General Hospital, Vancouver, Canada.
authors.forename: Fergal
authors.initials: F
authors.lastname: Donnellan
authors.affiliation: Gedyt Endoscopy Center, Buenos Aires, Argentina.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Dumonceau
authors.affiliation: Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
authors.forename: Robert G T
authors.initials: RG
authors.lastname: Glynne-Jones
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Jiménez-Perez
authors.affiliation: Endoscopy Unit, Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Meisner
authors.affiliation: Division of Gastroenterology and Hepatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States.
authors.forename: V Raman
authors.initials: VR
authors.lastname: Muthusamy
authors.affiliation: Royal College of Surgeons of England, London, UK.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Parker
authors.affiliation: Department of Digestive and Oncological Surgery, University Hospital of Amiens, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
authors.affiliation: Department of Digestive and Oncological Surgery, University Hospital of Amiens, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Sabbagh
authors.affiliation: Department of Colorectal Surgery, Royal Surrey County Hospital, Guildford, UK.
authors.forename: Jayesh
authors.initials: J
authors.lastname: Sagar
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Tanis
authors.affiliation: Department of Gastroenterology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.
authors.forename: Jo
authors.initials: J
authors.lastname: Vandervoort
authors.affiliation: Department of Gastroenterology, University College Hospital, London, UK.
authors.forename: George J
authors.initials: GJ
authors.lastname: Webster
authors.affiliation: Department of Gastroenterology and Endoscopy, Guido Salvini Hospital, Garbagnate Milanese/Rho, Milan, Italy.
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Manes
authors.affiliation: Department of Gastroenterology, Hôpital Nord, Aix Marseille Université, Marseille, France.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Barthet
authors.affiliation: Digestive Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
mesh_terms: D003110:Colonic Neoplasms / Q000150:complications*; D003113:Colonoscopy; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D018579:Patient Selection; D019919:Prosthesis Implantation / Q000379:methods; D015607:Stents