Colonic perforation after stent placement for malignant colorectal obstruction – causes and contributing factors

Abstract

Self-expanding metal stents (SEMS) are used to manage malignant colorectal obstruction. Colonic perforation is the most worrisome complication from colonic stenting. We reviewed causes and contributing factors of perforation with colonic stent placement in patients with malignant colorectal obstruction. Articles from both English and foreign language publications were identified from Medline. Data were collected on causes, timing, treatment and mortality related to perforation. A total of 2287 patients from 82 articles were included in this analysis, which showed an overall perforation rate of 4.9%. Perforation rates for palliation and bridge to surgery (BTS) were not significantly different (4.8% vs. 5.4%, p = 0.66); over 80% occurred within 30 days of stent placement (half during or within one day of the procedure). The mortality rate related to perforation was 0.8% per stented patient, but the mortality of patients experiencing perforation was 16.2%. There was no significant difference (p = 0.78) in the mortality rates between the palliation and the BTS group and concomitant chemotherapy, steroids, and radiotherapy are risk factors of perforation.

The overall perforation related mortality is far less than that of patients undergoing emergency surgery for bowel obstruction.

Key words::

• Perforation
• stent
• colon
• cancer
• risk factors

Acknowledgements

We would like to thank the following Boston Scientific employees for providing editorial comments: late Donald S Baim MD, Dana Washburn MD, Jay Schnitzer MD, Joy Peetermans, PhD and Brian Johnson.

Sources of Support: Boston Scientific Corporation, Natick, MA.

Declaration of interest: Dr. Datye and Dr. Hersh are full-time employees and stockholders of Boston Scientific Corporation, Natick, MA. The work presented in this paper has not been presented at any public conference.