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We thank Muharram for his interest in the use of self-expandable metallic stents (SEMS) in the management of malignant colorectal obstruction. SEMS was introduced in 1981 by Heasman, described as a ‘*stent system*’ \[[@b1-mjhid-3-1-e2011014]\]. SEMS are an important therapeutic option for malignant colorectal obstructions, but are not always used.
The following is an excerpt from an article by Devuyst et al \[[@b2-mjhid-3-1-e2011014]\], who looked into the use of SEMS in malignant colorectal obstructions: “There are many methods of palliation of malignant obstruction, including chemotherapy, radiation therapy, and surgery. Although SEMS placement is currently an accepted palliative therapy for palliation of colorectal obstruction, its use is not universal.”
In the same article, Devuyst et al state that “there are many small studies that demonstrate the safety and feasibility of SEMS. In addition, several randomized trials have shown that SEMSs are superior to emergency surgery.”
Muharram asked in particular whether the use of SEMS is superior to emergency surgery in patients with acute malignant colorectal obstruction.
Emergency surgery is a proven effective therapy for acute large bowel obstruction. The use of SEMS is a nonsurgical treatment and a result of a recent development in interventional radiology. Its indication is restricted to malignant large bowel obstruction. SEMS have been shown to be superior to radiologically placed nasoenteric tubes, but this is only true when the patient is not acutely ill (Tab. 1). An alternative to a SEMS is stent placement in a later stage of the disease process \[[@b3-mjhid-3-1-e2011014]\].
Many stents are available for the treatment of small bowel obstruction. The selection of one is based on the shape and length of the bowel, the type of obstruction, and the site of the obstruction
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i have table like this:
| | date | day |
|——— | ————— | ———|
| account1 | 2020-01-01 | monday |
| account1 | 2020-01-01 | tuesday |
| account1 | 2020-01-01 | wednesday |
| account1 | 2020-01-01 | thursday |
| account2 | 2020-01-02 | monday |
| account2 | 2020-01-02 | tuesday |