Malignant Acute Colonic Obstruction: Multidisciplinary Approach for Endoscopic Management

Simple Summary Acute colonic obstruction is one of the most common manifestations of locally advanced colorectal cancer. Endoscopic stenting has become by far the minimally invasive treatment of choice for malignant colonic obstruction especially in the palliative setting. However, there are still controversies in the literature about the usefulness and safety of endoscopic stenting as a bridge-to-surgery approach or in patients on antiangiogenic therapy. Moreover, endoscopic colonic stenting is an operative procedure that requires adequate pre-interventional management and specific endoscopic knowledge. The present review aimed to summarize the optimization of endoscopic management of patients with malignant acute colonic obstruction based on a multimodal connection with the various medical specialties involved in managing this urgent clinical scenario.Abstract 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.