University of Tennessee Health Science Center Memphis, TN
Yousef Abdel-Aziz, MD, MPH1, Faris Hammad, MD2, Sami Ghazaleh, MD3, Yazan Fahmawi, MD4, Dina Ahmad, MD1, Colin Howden, MBChB1, Mohammad Ismail, MD1; 1University of Tennessee Health Science Center, Memphis, TN; 2Saint Vincent Hospital, Cleveland, OH; 3University of Toledo Medical Center, Toledo, OH; 4University of South Alabama, Mobile, AL
Introduction: Acute colonic obstruction is a life-threating condition that can be the initial presentation in up to 20% of patients with colorectal cancer (CRC). Therefore, early diagnosis and intervention are crucial. Endoscopic management of colonic obstruction with self-expandable metal stent (SEMS) is the first line treatment for palliative decompression and it has been largely used as a bridging to surgery. Endoscopic SEMS insertion is feasible, safe, and effective. However, it is associated with several adverse events such as bleeding, pain, stent migration and the most serious; bowel perforation. Several studies reported increased risk of colonic perforation due to SEMS during Bevacizumab-based chemotherapy. In this study we are presenting a comparative analysis of increased risk of bowel Perforation with SEMS during bevacizumab-based chemotherapy Methods: We searched PubMed, Web of Science, and Scopus from inception to June 2020. We identified studies which reported colonic perforation in patients who underwent endoscopic SEMS insertion. The lists of references have been checked to detect any further studies. We compared the number of patients who developed colonic perforation in patients who received bevacizumab-based chemotherapy with patients who received non-bevacizumab-based chemotherapy or no chemotherapy. We measured the statistical Heterogenicity using I-Square method. Moreover, we calculated the odds ratio (OR) and confidence intervals (CI) using M-H and random models. Results: We included 5 retrospective studies published from 2009 to 2019, the locations where studies have been performed are USA, Spain, and Italy. A total number of 724 patients received SEMS during the study period. Mean age was 67.2 years and males constituted 53.7% of participants. A total of 43 perforations have been reported, 20 of 153 (13%) who received BV-based chemotherapy, and 23 of 571 (4%) who didn’t receive BV-based chemotherapy, with an OR of 7.6 (CI: 1.11-52.01, p = 0.04, I2 = 81%) (Figure 1). Funnel plot of standard error by log odds ratio showed visible symmetry suggesting no publication bias. Discussion: Despite the weak evidence by analysis of small retrospective studies, we conclude that Colonic perforation is 7.6 times more likely to happen in patients with SEMS during Bevacizumab-based chemotherapy. However, our conclusion is not enough to recommend a change in clinical practice. We recommend larger prospective studies with control groups to blame Bevacizumab
Figure 1: A total of 43 perforations have been reported, 20 of 153 (13%) who received BV-based chemotherapy, and 23 of 571 (4%) who didn’t receive BV-based chemotherapy, with an OR of 7.6 (CI: 1.11-52.01, p = 0.04, I2 = 81%)
Disclosures: Yousef Abdel-Aziz indicated no relevant financial relationships. Faris Hammad indicated no relevant financial relationships. Sami Ghazaleh indicated no relevant financial relationships. Yazan Fahmawi indicated no relevant financial relationships. Dina Ahmad indicated no relevant financial relationships. Colin Howden indicated no relevant financial relationships. Mohammad Ismail indicated no relevant financial relationships.