Perforation in colorectal stenting: A meta-analysis and a search for risk factors

Emo E. Van Halsema, Jeanin E. Van Hooft, Aaron J. Small, Todd H. Baron, Jesús García-Cano, JaeHee Cheon, Moon Sung Lee, Se Hwan Kwon, Stéphanie Mucci-Hennekinne, Paul Fockens, Marcel G.W. Dijkgraaf, Alessandro Repici

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Abstract

Background Recent studies suggest that there is a substantial risk of perforation after colorectal stent placement. Objective To identify risk factors for perforation from colonic stenting. Design A meta-analysis of 86 studies published between 2005 and 2011. Setting Multicenter review. Patients All patients who underwent colorectal stent placement. Intervention Colorectal stent placement. Main Outcome Measurements The occurrence of perforation with subgroup analyses for stent design, stricture etiology, stricture dilation, and concomitant chemotherapy, including the use of bevacizumab. Results A total of 4086 patients underwent colorectal stent placement; perforation occurred in 207. Meta-analysis revealed an overall perforation rate of 7.4%. Of the 9 most frequently used stent types, the WallFlex, the Comvi, and the Niti-S D-type had a higher perforation rate (>10%). A lower perforation rate (<5%) was found for the Hanarostent and the Niti-S covered stent. Stenting benign strictures was associated with a significantly increased perforation rate of 18.4% compared with 7.5% for malignant strictures. Dilation did not increase the risk of perforation: 8.5% versus 8.5% without dilation. The subgroup of post-stent placement dilation had a significantly increased perforation risk of 20.4%. With a perforation rate of 12.5%, bevacizumab-based therapy was identified as a risk factor for perforation, whereas the risk for chemotherapy without bevacizumab was 7.0% and not increased compared with the group without concomitant therapies during stent therapy (9.0%). Limitations Heterogeneity; a considerable proportion of data is unavailable for subgroup analysis. Conclusions The perforation rate of colonic stenting is 7.4%. Stent design, benign etiology, and bevacizumab were identified as risk factors for perforation. Intraprocedural stricture dilation and concomitant chemotherapy were not associated with an increased risk of perforation.

Original languageEnglish
JournalGastrointestinal Endoscopy
Volume79
Issue number6
DOIs
Publication statusPublished - 2014 Jan 1

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Stents
Meta-Analysis
Dilatation
Pathologic Constriction
Drug Therapy
Therapeutics
Bevacizumab

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Van Halsema, E. E., Van Hooft, J. E., Small, A. J., Baron, T. H., García-Cano, J., Cheon, J., ... Repici, A. (2014). Perforation in colorectal stenting: A meta-analysis and a search for risk factors. Gastrointestinal Endoscopy, 79(6). https://doi.org/10.1016/j.gie.2013.11.038
Van Halsema, Emo E. ; Van Hooft, Jeanin E. ; Small, Aaron J. ; Baron, Todd H. ; García-Cano, Jesús ; Cheon, JaeHee ; Lee, Moon Sung ; Kwon, Se Hwan ; Mucci-Hennekinne, Stéphanie ; Fockens, Paul ; Dijkgraaf, Marcel G.W. ; Repici, Alessandro. / Perforation in colorectal stenting : A meta-analysis and a search for risk factors. In: Gastrointestinal Endoscopy. 2014 ; Vol. 79, No. 6.
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title = "Perforation in colorectal stenting: A meta-analysis and a search for risk factors",
abstract = "Background Recent studies suggest that there is a substantial risk of perforation after colorectal stent placement. Objective To identify risk factors for perforation from colonic stenting. Design A meta-analysis of 86 studies published between 2005 and 2011. Setting Multicenter review. Patients All patients who underwent colorectal stent placement. Intervention Colorectal stent placement. Main Outcome Measurements The occurrence of perforation with subgroup analyses for stent design, stricture etiology, stricture dilation, and concomitant chemotherapy, including the use of bevacizumab. Results A total of 4086 patients underwent colorectal stent placement; perforation occurred in 207. Meta-analysis revealed an overall perforation rate of 7.4{\%}. Of the 9 most frequently used stent types, the WallFlex, the Comvi, and the Niti-S D-type had a higher perforation rate (>10{\%}). A lower perforation rate (<5{\%}) was found for the Hanarostent and the Niti-S covered stent. Stenting benign strictures was associated with a significantly increased perforation rate of 18.4{\%} compared with 7.5{\%} for malignant strictures. Dilation did not increase the risk of perforation: 8.5{\%} versus 8.5{\%} without dilation. The subgroup of post-stent placement dilation had a significantly increased perforation risk of 20.4{\%}. With a perforation rate of 12.5{\%}, bevacizumab-based therapy was identified as a risk factor for perforation, whereas the risk for chemotherapy without bevacizumab was 7.0{\%} and not increased compared with the group without concomitant therapies during stent therapy (9.0{\%}). Limitations Heterogeneity; a considerable proportion of data is unavailable for subgroup analysis. Conclusions The perforation rate of colonic stenting is 7.4{\%}. Stent design, benign etiology, and bevacizumab were identified as risk factors for perforation. Intraprocedural stricture dilation and concomitant chemotherapy were not associated with an increased risk of perforation.",
author = "{Van Halsema}, {Emo E.} and {Van Hooft}, {Jeanin E.} and Small, {Aaron J.} and Baron, {Todd H.} and Jes{\'u}s Garc{\'i}a-Cano and JaeHee Cheon and Lee, {Moon Sung} and Kwon, {Se Hwan} and St{\'e}phanie Mucci-Hennekinne and Paul Fockens and Dijkgraaf, {Marcel G.W.} and Alessandro Repici",
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Van Halsema, EE, Van Hooft, JE, Small, AJ, Baron, TH, García-Cano, J, Cheon, J, Lee, MS, Kwon, SH, Mucci-Hennekinne, S, Fockens, P, Dijkgraaf, MGW & Repici, A 2014, 'Perforation in colorectal stenting: A meta-analysis and a search for risk factors', Gastrointestinal Endoscopy, vol. 79, no. 6. https://doi.org/10.1016/j.gie.2013.11.038

Perforation in colorectal stenting : A meta-analysis and a search for risk factors. / Van Halsema, Emo E.; Van Hooft, Jeanin E.; Small, Aaron J.; Baron, Todd H.; García-Cano, Jesús; Cheon, JaeHee; Lee, Moon Sung; Kwon, Se Hwan; Mucci-Hennekinne, Stéphanie; Fockens, Paul; Dijkgraaf, Marcel G.W.; Repici, Alessandro.

In: Gastrointestinal Endoscopy, Vol. 79, No. 6, 01.01.2014.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Perforation in colorectal stenting

T2 - A meta-analysis and a search for risk factors

AU - Van Halsema, Emo E.

AU - Van Hooft, Jeanin E.

AU - Small, Aaron J.

AU - Baron, Todd H.

AU - García-Cano, Jesús

AU - Cheon, JaeHee

AU - Lee, Moon Sung

AU - Kwon, Se Hwan

AU - Mucci-Hennekinne, Stéphanie

AU - Fockens, Paul

AU - Dijkgraaf, Marcel G.W.

AU - Repici, Alessandro

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background Recent studies suggest that there is a substantial risk of perforation after colorectal stent placement. Objective To identify risk factors for perforation from colonic stenting. Design A meta-analysis of 86 studies published between 2005 and 2011. Setting Multicenter review. Patients All patients who underwent colorectal stent placement. Intervention Colorectal stent placement. Main Outcome Measurements The occurrence of perforation with subgroup analyses for stent design, stricture etiology, stricture dilation, and concomitant chemotherapy, including the use of bevacizumab. Results A total of 4086 patients underwent colorectal stent placement; perforation occurred in 207. Meta-analysis revealed an overall perforation rate of 7.4%. Of the 9 most frequently used stent types, the WallFlex, the Comvi, and the Niti-S D-type had a higher perforation rate (>10%). A lower perforation rate (<5%) was found for the Hanarostent and the Niti-S covered stent. Stenting benign strictures was associated with a significantly increased perforation rate of 18.4% compared with 7.5% for malignant strictures. Dilation did not increase the risk of perforation: 8.5% versus 8.5% without dilation. The subgroup of post-stent placement dilation had a significantly increased perforation risk of 20.4%. With a perforation rate of 12.5%, bevacizumab-based therapy was identified as a risk factor for perforation, whereas the risk for chemotherapy without bevacizumab was 7.0% and not increased compared with the group without concomitant therapies during stent therapy (9.0%). Limitations Heterogeneity; a considerable proportion of data is unavailable for subgroup analysis. Conclusions The perforation rate of colonic stenting is 7.4%. Stent design, benign etiology, and bevacizumab were identified as risk factors for perforation. Intraprocedural stricture dilation and concomitant chemotherapy were not associated with an increased risk of perforation.

AB - Background Recent studies suggest that there is a substantial risk of perforation after colorectal stent placement. Objective To identify risk factors for perforation from colonic stenting. Design A meta-analysis of 86 studies published between 2005 and 2011. Setting Multicenter review. Patients All patients who underwent colorectal stent placement. Intervention Colorectal stent placement. Main Outcome Measurements The occurrence of perforation with subgroup analyses for stent design, stricture etiology, stricture dilation, and concomitant chemotherapy, including the use of bevacizumab. Results A total of 4086 patients underwent colorectal stent placement; perforation occurred in 207. Meta-analysis revealed an overall perforation rate of 7.4%. Of the 9 most frequently used stent types, the WallFlex, the Comvi, and the Niti-S D-type had a higher perforation rate (>10%). A lower perforation rate (<5%) was found for the Hanarostent and the Niti-S covered stent. Stenting benign strictures was associated with a significantly increased perforation rate of 18.4% compared with 7.5% for malignant strictures. Dilation did not increase the risk of perforation: 8.5% versus 8.5% without dilation. The subgroup of post-stent placement dilation had a significantly increased perforation risk of 20.4%. With a perforation rate of 12.5%, bevacizumab-based therapy was identified as a risk factor for perforation, whereas the risk for chemotherapy without bevacizumab was 7.0% and not increased compared with the group without concomitant therapies during stent therapy (9.0%). Limitations Heterogeneity; a considerable proportion of data is unavailable for subgroup analysis. Conclusions The perforation rate of colonic stenting is 7.4%. Stent design, benign etiology, and bevacizumab were identified as risk factors for perforation. Intraprocedural stricture dilation and concomitant chemotherapy were not associated with an increased risk of perforation.

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U2 - 10.1016/j.gie.2013.11.038

DO - 10.1016/j.gie.2013.11.038

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JO - Gastrointestinal Endoscopy

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