Self-expandable metallic stents in pregnant patients with obstructing colorectal cancer

We applaud Lamazza and associates [1] for their exhaustive and didactic study on self-expandable metallic stents (SEMS) employed in patients with stage IV obstructing colorectal cancer (CRC). In particular, we appreciated the following topics: the higher feasibility, expedience, and safety of endoscopic stenting by passing the guide wire under direct vision (using a pediatric nasogastroscope) versus a blind positioning technique, its undoubtedly more positive psychoemotional effect on patients in comparison with a diverting colostomy, the need of surveillance for patients with SEMS in order to promptly recognize and profitably treat the obstruction secondary to fecal impaction, tumor ingrowth within the stent or its dislodgement with possible bleeding or perforation. As for us, we are interested in exploring another field of application of SEMS, which is represented by its placement in pregnant patients affected by obstructing colorectal cancer, and we are looking forward to knowing their opinion about that. Recently, in fact, we had to choose between SEMS placement or diverting colostomy for a secondipara 32-year-old patient diagnosed as having a stage IV obstructing colorectal adenocarcinoma in the early postpartum period. After water-soluble enema showed complete stenosis at the rectosigmoid junction, we thought endoscopic stenting a procedure too hazardous to perform and instead performed a colostomy. As of this writing, the patient is receiving a first-line chemotherapy regimen with FOLFOX plus cetuximab while she waits for elective tumor resection.