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.
  
  
  METHODS
  A meta-analysis of 86 studies published between 2005 and 2011.
  
  
  METHODS
  Multicenter review.
  
  
  METHODS
  All patients who underwent colorectal stent placement.
  
  
  METHODS
  Colorectal stent placement.
  
  
  METHODS
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Emo E
authors.initials: EE
authors.lastname: van Halsema
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Jeanin E
authors.initials: JE
authors.lastname: van Hooft
authors.affiliation: Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Small
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.affiliation: Department of Gastroenterology, Hospital Virgen de la Luz, Cuenca, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: García-Cano
authors.affiliation: Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cheon
authors.affiliation: Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea.
authors.forename: Moon Sung
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Department of Radiology, Kyung Hee University Medical Center, Seoul, Korea.
authors.forename: Se Hwan
authors.initials: SH
authors.lastname: Kwon
authors.affiliation: Department of Visceral Surgery, Centre Hospitalier Universitaire d'Angers, Angers, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Mucci-Hennekinne
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.affiliation: Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marcel G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.affiliation: Department of Digestive Endoscopy, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
mesh_terms: D003106:Colon / Q000293:injuries*; D003108:Colonic Diseases / Q000601:surgery*; D014943:Global Health; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000601:surgery*; D007416:Intestinal Perforation / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D007431:Intraoperative Complications; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*