TY - JOUR
T1 - Surgery or stenting for colonic obstruction
T2 - A practice management guideline from the Eastern Association for the Surgery of Trauma
AU - Ferrada, Paula
AU - Patel, Mayur B.
AU - Poylin, Vitaliy
AU - Bruns, Brandon R.
AU - Leichtle, Stefan W.
AU - Wydo, Salina
AU - Sultan, Shahnaz
AU - Haut, Elliott R.
AU - Robinson, Bryce
N1 - Publisher Copyright:
© 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016
Y1 - 2016
N2 - Background: Colonic obstruction is a surgical emergency, and delay in decompression results in added morbidity and mortality. Advances have led to less invasive procedures such as stenting as a bridge for definitive surgery. The aim of this article was to perform a systematic review regarding colon obstruction (malignant or benign) and to provide recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. METHODS: A systematic literature review was conducted using the PubMed, EMBASE, and the Cochrane Library databases of published studies. The search was last performed on January 2, 2015. Two independent reviewers extracted the desired variables from the studies. For our metaanalysis, we used Review Manager X.6 (RevMan). Recommendations are provided using GRADE methodology. A single Population, Intervention, Comparator, Outcome (PICO) question with two outcomes was addressed as follows: Population: in adult patients with a colonic obstruction (malignant or benign). Intervention: should surgery be performed. Comparator: versus endoscopic stenting. Outcomes: decreased mortality and decreased emergency, nonplanned procedures? RESULTS: The search yielded 210 results. Screening of the titles excluded 102 articles, leaving 108 for review. After abstract review, 71 additional articles were excluded because of failure to address the PICO questions of this guideline. Thirty-seven articles were reviewed in their entirety, of those six randomized control trials that evaluated the use of stents versus emergency surgery in colonic obstruction caused by malignant disease were included in the final qualitative review. CONCLUSION: We conditionally recommend endoscopic, colonic stenting (if available) as initial therapy for colonic obstruction. In our review, stent use was associated with decreased mortality and rates for emergency, nonplanned procedures to include reoperations. This conditional recommendation is limited to those with malignancy because of the lack of literature supporting this practice in benign colonic disease.
AB - Background: Colonic obstruction is a surgical emergency, and delay in decompression results in added morbidity and mortality. Advances have led to less invasive procedures such as stenting as a bridge for definitive surgery. The aim of this article was to perform a systematic review regarding colon obstruction (malignant or benign) and to provide recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. METHODS: A systematic literature review was conducted using the PubMed, EMBASE, and the Cochrane Library databases of published studies. The search was last performed on January 2, 2015. Two independent reviewers extracted the desired variables from the studies. For our metaanalysis, we used Review Manager X.6 (RevMan). Recommendations are provided using GRADE methodology. A single Population, Intervention, Comparator, Outcome (PICO) question with two outcomes was addressed as follows: Population: in adult patients with a colonic obstruction (malignant or benign). Intervention: should surgery be performed. Comparator: versus endoscopic stenting. Outcomes: decreased mortality and decreased emergency, nonplanned procedures? RESULTS: The search yielded 210 results. Screening of the titles excluded 102 articles, leaving 108 for review. After abstract review, 71 additional articles were excluded because of failure to address the PICO questions of this guideline. Thirty-seven articles were reviewed in their entirety, of those six randomized control trials that evaluated the use of stents versus emergency surgery in colonic obstruction caused by malignant disease were included in the final qualitative review. CONCLUSION: We conditionally recommend endoscopic, colonic stenting (if available) as initial therapy for colonic obstruction. In our review, stent use was associated with decreased mortality and rates for emergency, nonplanned procedures to include reoperations. This conditional recommendation is limited to those with malignancy because of the lack of literature supporting this practice in benign colonic disease.
KW - Colonic obstruction
KW - Guidelines
KW - Large bowel obstruction
KW - Meta-analysis
KW - Surgical treatment of colon obstruction
KW - Systematic review
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U2 - 10.1097/TA.0000000000000966
DO - 10.1097/TA.0000000000000966
M3 - Review article
C2 - 26808035
AN - SCOPUS:84955578524
SN - 2163-0755
VL - 80
SP - 659
EP - 664
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 4
ER -