AI Article Synopsis

  • Preoperative intestinal decompression can be done using self-expandable metallic stents (SEMS) or transanal decompression tubes (TDT) as alternatives to emergency surgery for malignant large-bowel obstruction (MLBO).
  • A meta-analysis of 14 studies involving 581 patients showed that SEMS placement (BTS) offered better technical success and clinical outcomes, allowing patients to eat freely and potentially have less invasive surgery.
  • The study suggests that while long-term effects are still unclear, the SEMS placement strategy could become the preferred method for managing preoperative decompression in MLBO cases.

Article Abstract

Purpose: Preoperative intestinal decompression, using either a self-expandable metallic stent (SEMS) as a bridge to surgery (BTS) or a transanal decompression tube (TDT), provides an alternative to emergency surgery for malignant large-bowel obstruction (MLBO). We conducted this meta-analysis to compare the short-term outcomes of SEMS placement as a BTS vs. TDT placement for MLBO.

Methods: We conducted a comprehensive electronic search of literature published up to March, 2018, to identify studies comparing the short-term outcomes of BTS vs. TDT. Decompression device-related and surgery-related variables were evaluated and a meta-analysis was performed using random-effects models to calculate odd ratios with 95% confidence intervals.

Results: We analyzed 14 nonrandomized studies with a collective total of 581 patients: 307 (52.8%) who underwent SEMS placement as a BTS and 274 (47.2%) who underwent TDT placement. The meta-analyses showed that the BTS strategy conferred significantly better technical and clinical success, helped to maintain quality of life by allowing free food intake and temporal discharge, promoted laparoscopic one-stage surgery without stoma creation, and had equivalent morbidity and mortality to TDT placement.

Conclusions: Although the long-term outcomes are as yet undetermined, the BTS strategy using SEMS placement could be a new standard of care for preoperative decompression to manage MLBO.

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Source
http://dx.doi.org/10.1007/s00595-019-01784-yDOI Listing

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