Palliative Stenting for Malignant Large Bowel Obstruction: Stents for All?

used as a bridge to surgery?” [1–5] . It is clear that 8 years ago, the use of a stent preoperatively was considered the standard of care and highly recommended in every tertiary center [6, 7] . Furthermore, the use of a stent as a definitive palliative treatment for the remaining life of a patient was still a matter of debate. However, today, in December 2016, everything is reversed. In 2014, the European Society of Gastrointestinal Endoscopy (ESGE) presented guidelines for the use of metallic stents in obstructive colorectal cancer [8] . The special focus is on 2 items: (a) SEMS placement as a bridge to elective surgery is not recommended as a standard treatment of symptomatic left-sided malignant colonic obstruction. For patients with potentially curable but obstructing left-sided colonic cancer, stent placement may be considered as an alternative to emergency surgery in those who have an increased risk of postoperative mortality, i.e., American Society of Anesthesiologists (ASA) physical status ≥ III and/or age >70 years. In addition, to create the perfect scenario for a huge debate, the so-called poor son returned in glory: (b) SEMS placement is recommended as the preferred treatment for palliation of malignant colonic obstruction, except in patients treated or considered for treatment with antiangiogenic drugs (e.g., bevacizumab). How did we arrive at this conclusion?