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

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

doi:10.1016/j.gie.2013.11.038

Cited by 157 publications

(107 citation statements)

References 118 publications

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“…22,57,59 A recent meta-analysis investigated risk factors for increased perforation rate. 25 Chemotherapy without bevacizumab was not associated with a significantly increased risk (7.0%), but use of bevacizumanb was (12.5%). Perforation rate in those who did not receive chemotherapy was 9.0%.…”

Section: Palliative Semsmentioning

confidence: 90%

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Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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Acute colonic obstruction secondary to left-colonic malignancy remains a common emergency condition. Traditional management is emergency surgery and has high morbidity and mortality. Self expandable metallic stents (SEMS) promised to improve morbidity and mortality, stoma rates and hospital stay. SEMS use in the potentially curative setting, as a bridge to surgery, is associated with an improved stoma rate and morbidity, but has no mortality benefit. There are concerns about oncological safety with higher local recurrence rates, thus SEMS is not recommended in this setting unless the patient has increased surgical risk and would benefit from a period of recovery prior to surgery. SEMS has a definite role in the palliative setting, for both patients with incurable disease or those with a high surgical risk. SEMS is associated with improved morbidity, mortality, and stoma rates. The technique for SEMS insertion is now well established but it is still unclear whether covered or uncovered stents are better.

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Section: Palliative Semsmentioning

confidence: 90%

“…[21][22][23] Systematic review and meta-analysis of retrospective data suggests an increased risk of perforation colonic perforation with stricture dilatation. 24,25 Enteral SEMS may be covered or uncovered. In the setting of malignant colonic obstruction; the two designs are equally safe and effective.…”

Section: General Considerations and Techniquementioning

confidence: 99%

Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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“…Free perforation occurs in 3.8% to 6.9% of patients treated [27] resulting in seeding of neoplastic cells in the abdominal cavity (peritoneal carcinomatosis). Almost 70% of colon perforations occurs in the first week after stenting and it could have a negative effect on long term survival, especially in patients whose disease is potentially curable.…”

Section: Risk Of Perforation After Sems Insertionmentioning

confidence: 99%

“…Van Halsema identified as risk factors for perforation, benign etiology of the stricture, and chemotherapy with bevacizumab [27,32,33] . Type of stent: Selection of the appropriate stent is very important for outcomes, considering material, design, diameter, length, radial force, flexibility, foreshortening ratio, and delivery system but there is no evidence to indicate which stent type is superior.…”

mentioning

confidence: 99%

Colonic Stenting in the Management of Acute Left-sided Malignant Colonic Obstruction is Oncologically Safe?

Belinda

Catena

2017

Journal of Tumor

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stoma creation in comparison with emergency surgery, enhancing patients' quality of life, without differences in terms of mortality and morbidity rate. According to available data, at one year follow up time, the recurrence rate is higher in patients treated with stent, with no statistical difference in terms of disease free survival and overall survival. Endoscopist's experience, type of colic obstruction (partial or total), type of stent, insertion technique and timing of surgery are fundamental to reach CS technical and clinical success. Oncologic (un)-safety of colonic stenting has to be still investigated and confirmed by medium and long term follow up of large prospective studies and randomized controlled trials comparing SEMS as bridge to surgery and ES. CS can be strongly considered with palliative intent in patients with advanced neoplastic disease, to avoid stoma and health care costs related to stoma.

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“…Bevacizumab is a recombinant monoclonal antibody that blocks angiogenesis, thereby inhibiting tumor growth. In patients undergoing bevacizumab treatment, perforation risks of 0.9 % in general [1] and 12.5 % following colonic stenting [2] have been reported. Recent colonoscopy (< 1 month) is a risk factor for bevacizumab-related perforation [1].…”

mentioning

confidence: 99%

Colonic perforation following endoscopic mucosal resection in a patient on bevacizumab treatment

et al. 2016

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An 81-year-old woman who had previously undergone left hemicolectomy for an adenocarcinoma (pT3 N1) of the descending colon was diagnosed with a 2-cm flat polyp in the transverse colon during surveillance colonoscopy (• " Fig. 1 a). Subsequently, she also developed liver metastases and underwent three cycles of neoadjuvant chemotherapy with leucovorin, 5-fluorouracil, irinotecan, and bevacizumab (325 mg per cycle). Five days following the last infusion, she underwent colonoscopy with piecemeal endoscopic mucosal resection (EMR) of the polyp. The polyp margins were treated with hot biopsy forceps (• " Fig. 1 b,

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

Cited by 157 publications

References 118 publications

Colonic cancer: The current role of stent insertion

Colonic cancer: The current role of stent insertion

Colonic Stenting in the Management of Acute Left-sided Malignant Colonic Obstruction is Oncologically Safe?

Colonic perforation following endoscopic mucosal resection in a patient on bevacizumab treatment

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