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This study aimed to compare surgical outcomes between SEMS as a bridge to surgery (BTS) and ES in patients with malignant colorectal obstruction.Methods: A comprehensive database search was conducted until October 2023 to compare outcomes between SEMS as a BTS and ES. A subgroup analysis of results by malignancy site was performed.Results: We analyzed 57 studies, including 7,223 patients over a mean duration of 35.4 months. SEMS as a BTS showed clinical and technical success rates of 88.0% (95% confidence interval [CI], 86.1%\u201390.1%; I2=68%) and 91.6% (95% CI, 89.7%\u201393.7%; I2=66%), respectively. SEMS as a BTS revealed reduced postoperative adverse events (odds ratio [OR], 0.51; 95% CI, 0.41\u20130.63; I2=70%; p&lt;0.001) and 30-day mortality (OR, 0.52; 95% CI, 0.37\u20130.72; I2=10%; p&lt;0.001) compared to ES. Subgroup analysis showed postoperative mortality of 5% and 1.5% for left- and right-sided malignancies, respectively. Adverse events were 15% and 33% for the right and left colon, respectively.Conclusions: SEMS as a BTS demonstrated a higher success rate, fewer postoperative adverse events, and a reduced 30-day mortality rate than ES, supporting its use as the preferred initial intervention for right- and left-sided obstructions and indicating broader clinical adoption.<\/jats:p>","DOI":"10.5946\/ce.2024.120","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T07:09:41Z","timestamp":1738566581000},"page":"240-252","update-policy":"https:\/\/doi.org\/10.5946\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and 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