Abstract
Stent (SEMS: self-expandable metallic stent) treatment for the colon and rectum finally became available beginning in 2012 in Japan within the public health insurance system. In this review, we describe the present conditions and future prospects taking data from the literature into consideration. The current indication in Japan is malignant colorectal stenosis including palliation and serving as a bridge to surgery (BTS).
Colonic stenosis is not rare in the terminal period in the cancer patient. As palliative treatment, colonic stenting is becoming popular as an alternative to colonic stoma. Colonic stent not only prevents stoma creation, but also achieves quick intestinal decompression without any discomfort such as abdominal pain. However, during follow-up after the stent, complications might occur in 30~40% of patients. It is important to create a system with endoscopists and surgeons which can support re-intervention and surgery.
In BTS, short duration of hospitalization, as well as reduced postoperative complications, colostomy rate, and mortality rate are expected as compared to emergency surgery. Although it has been reported that the complication rate is low, adequate preparation and informed consent are important because complications can still occur. There are some tips and points to be taken into consideration to achieve safe procedures. The occurrence of complications can be minimized by following these. The Colonic Stent Safe Procedure Research Group, one of the subordinate organizations of the Japan Society for Gastrointestinal Endoscopy, has put together a set of mini-guidelines for use of the colon stent, and the mini-guidelines have been published on the Society's website.
The long-term prognosis is still unknown in BTS, and even the ESGE clinical guidelines do not recommend BTS as a standard treatment. A large prospective study is needed.
