title: Surgery or stenting for colonic obstruction: A practice management guideline from the Eastern Association for the Surgery of Trauma.
abstract: BACKGROUND
  Colonic obstruction is a surgical emergency, and delay in decompression results in added morbidity and mortality. Advances have led to less invasive procedures such as stenting as a bridge for definitive surgery. The aim of this article was to perform a systematic review regarding colon obstruction (malignant or benign) and to provide recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.
  
  
  METHODS
  A systematic literature review was conducted using the PubMed, EMBASE, and the Cochrane Library databases of published studies. The search was last performed on January 2, 2015. Two independent reviewers extracted the desired variables from the studies. For our meta-analysis, we used Review Manager X.6 (RevMan). Recommendations are provided using GRADE methodology. A single POPULATION, Intervention, Comparator, Outcome (PICO) question with two outcomes was addressed as follows:
  
  
  METHODS
  in adult patients with a colonic obstruction (malignant or benign).
  
  
  METHODS
  should surgery be performed.Comparator: versus endoscopic stenting.
  
  
  RESULTS
  decreased mortality and decreased emergency, nonplanned procedures?
  
  
  RESULTS
  The search yielded 210 results. Screening of the titles excluded 102 articles, leaving 108 for review. After abstract review, 71 additional articles were excluded because of failure to address the PICO questions of this guideline. Thirty-seven articles were reviewed in their entirety, of those six randomized control trials that evaluated the use of stents versus emergency surgery in colonic obstruction caused by malignant disease were included in the final qualitative review.
  
  
  CONCLUSIONS
  We conditionally recommend endoscopic, colonic stenting (if available) as initial therapy for colonic obstruction. In our review, stent use was associated with decreased mortality and rates for emergency, nonplanned procedures to include reoperations. This conditional recommendation is limited to those with malignancy because of the lack of literature supporting this practice in benign colonic disease.
authors.affiliation: From the Virginia Commonwealth University (P.F.), Richmond Virginia; Vanderbilt University Medical Center, Departments of Surgery and Neurosurgery; Nashville VA Medical Center, Tennessee Valley Healthcare System (M.B.P.), Nashville, Tennessee; Beth Israel Deaconess Medical Center (V.P.), Boston Massachusetts; Division of Acute Care Surgery, University of Maryland Medical Center (B.R.B.); and Johns Hopkins (E.R.H.), University Bloomberg School of Public Health, Baltimore, Maryland; LAC+USC Medical Center (S.W.L.), University of Southern California, Los Angeles, California; Cooper University Hospital (S.W.), Philadelphia, Pennsylvania; University of Florida (S.S.), Gainesville, Florida; and University of Washington (B.R.), Harborview Medical Center, Seattle, Washington.
authors.forename: Paula
authors.initials: P
authors.lastname: Ferrada
authors.forename: Mayur B
authors.initials: MB
authors.lastname: Patel
authors.forename: Vitaliy
authors.initials: V
authors.lastname: Poylin
authors.forename: Brandon R
authors.initials: BR
authors.lastname: Bruns
authors.forename: Stefan W
authors.initials: SW
authors.lastname: Leichtle
authors.forename: Salina
authors.initials: S
authors.lastname: Wydo
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Sultan
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: Bryce
authors.initials: B
authors.lastname: Robinson
mesh_terms: D000328:Adult; D003108:Colonic Diseases / Q000601:surgery*; D019299:Decompression, Surgical; D013505:Digestive System Surgical Procedures; D004630:Emergencies; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D015607:Stents