Patients presenting with acute colonic obstruction are usually evaluated in the emergency department and multiple specialties are involved in the patients’ management. Pre-treatment evaluation is essential in order to establish the correct endoscopic indication for stent implantation. Contrast-enhanced imaging could allow the exclusion of benign causes of colonic obstruction and evaluation of the length of malignant stricture. Endoscopic stenting is the gold standard of treatment for palliative indications whereas there are still concerns about its use as a bridge to surgery. Different meta-analyses showed that stenting as a bridge to surgery improves short-term surgical outcomes but has no role in improving long-term outcomes. Multidisciplinary evaluation is also essential in patients that may be started on or are currently receiving antiangiogenic agents because endoscopic stenting may increase the risk of perforation. Evidence in the literature is weak and based on retrospective data. Here we report on how to correctly evaluate a patient with acute colonic malignant obstruction in collaboration with other essential specialists including a radiologist, surgeon and oncologist, and how to optimize the technique of endoscopic stenting.
急性结肠梗阻患者通常在急诊科接受评估，其治疗过程涉及多个专科。治疗前评估对于确定支架植入的正确内镜指征至关重要。增强影像学检查有助于排除结肠梗阻的良性病因，并评估恶性狭窄的长度。对于姑息治疗指征，内镜下支架植入是治疗的金标准，但其作为手术桥梁的应用仍存在争议。多项荟萃分析表明，支架作为手术桥梁可改善短期手术效果，但对长期预后无改善作用。对于可能开始或正在接受抗血管生成药物治疗的患者，多学科评估同样必不可少，因为内镜下支架植入可能增加穿孔风险。现有文献证据薄弱，主要基于回顾性数据。本文旨在探讨如何与放射科医师、外科医师及肿瘤科医师等关键专科医生协作，正确评估急性结肠恶性梗阻患者，并优化内镜下支架植入技术。
Malignant Acute Colonic Obstruction: Multidisciplinary Approach for Endoscopic Management
肿瘤(癌症)患者之家