Current Status of “Bridge to Surgery” Using a Self-expandable Metallic Stent for Obstructive Colorectal Cancer

Abstract

After gaining health insurance coverage in 2012, intestinal decompression using a self-expandable metallic stent (SEMS) for malignant large bowel obstruction (MLBO) has spread rapidly in Japan. Regarding preoperative decompression using SEMS, called “bridge to surgery” (BTS), there are concerns about the long-term outcomes; the guideline from the European Society of Gastrointestinal Endoscopy (ESGE) 2014 did not recommend BTS as a standard therapy for left-sided MLBO. Recent meta-analyses and large-scale retrospective studies using propensity score matching regarding the long-term outcomes demonstrated equivalent survivals, but the possibility of higher recurrence rates, compared with emergency surgery. The updated ESGE guideline 2020 recommended that BTS be discussed within a shared decision-making process as a treatment option. However, a number of clinical questions in the BTS strategy, concerning long-term outcomes, interval from SEMS placement to surgery, type of SEMS, application in right-sided MLBO, and comparison with transanal decompression tube, are still under investigation. To secure the safety and efficacy of BTS, compliance with strict indications and experienced skills of endoscopic procedures, which are emphasized in the guideline, are indispensable. This review describes the current status of BTS for MLBO and the future perspectives of this less invasive and promising treatment strategy.