Colorectal stents for the management of malignant colonic obstructions

Jayesh Sagar

doi:10.1002/14651858.CD007378.pub2

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Figure 1

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 3

Forest plot of comparison: Clinical Relief of Obstruction

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Figure 4

Forest plot of comparison: 30 Day Mortality

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Figure 5

Forest plot of comparison: Complications

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Figure 6

Forest plot of comparison: Major Wound Complication

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Figure 7

Funnel plot of comparison: Clinical Relief of Obstruction

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Figure 8

Funnel plot of comparison: 30 Day Mortality

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Figure 9

Funnel plot of comparison: Complications

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Figure 10

Funnel plot of comparison: Major Wound Complication

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Analysis 1.1

Comparison 1 Clinical Relief ‐ Colonic stent Vs Emergency surgery, Outcome 1 Clinical Relief of Obstruction ‐ Numbers.

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Study	Colonic Stent	Emergency Surgery
Cheung 2009	1 day	Not mentioned
Fiori 2004	1 day	3.1 days
van Hooft 2008	0 day	4 days

Analysis 1.2

Comparison 1 Clinical Relief ‐ Colonic stent Vs Emergency surgery, Outcome 2 Clinical Relief of Obstruction ‐ Time.

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Study	Successful Placement	Attempted Placement
Cheung 2009	20	24
Fiori 2004	11	11
Sankararajah 2005	7	9
van Hooft 2008	9	11
van Hooft 2011	33	47

Analysis 2.1

Comparison 2 Technical Success ‐ Colonic Stent, Outcome 1 Technical Success Rates ‐ Colonic Stent.

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Analysis 3.1

Comparison 3 Other Outcomes, Outcome 1 30 Day Mortality.

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Study	Stent Procedure Related Perforation (Clinical)	Total Attempted stents
Cheung 2009	0	24
Fiori 2004	0	11
Sankararajah 2005	0	9
van Hooft 2008	6	11
van Hooft 2011	6	47

Analysis 3.2

Comparison 3 Other Outcomes, Outcome 2 Stent Related Perforation.

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Analysis 3.3

Comparison 3 Other Outcomes, Outcome 3 Complications.

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Analysis 3.4

Comparison 3 Other Outcomes, Outcome 4 Major Wound Complication.

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Study	Stent Migration	Total Successful Stents Inserted
Cheung 2009	0	20
Fiori 2004	0	11
Sankararajah 2005	1	7
van Hooft 2008	1	9
van Hooft 2011	0	47

Analysis 3.5

Comparison 3 Other Outcomes, Outcome 5 Stent Migration.

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Study	Colonic Stent	Emergency Surgery
Cheung 2009	13.5 Days (Median)	14 Days (Median)
Fiori 2004	2.6 Days (Median)	8.6 Days (Median)
Sankararajah 2005	18 Days (Mean)	35 Days (Mean)
van Hooft 2008	12 Day (Median)	11 Days (Median)

Analysis 3.6

Comparison 3 Other Outcomes, Outcome 6 Hospital Stay.

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Study	Colonic Stent	Emergency Surgery
Cheung 2009	130 Minutes (Median)	170 Minutes (Median)
Fiori 2004	36.8 Minutes	75.4 Minutes
Sankararajah 2005	175 Minutes	208 Minutes
van Hooft 2008		122 Minutes

Analysis 3.7

Comparison 3 Other Outcomes, Outcome 7 Procedure/Operating Time.

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Study	Colonic Stent	Emergency Surgery
Cheung 2009	50 mls (Median)	200 mls (Median)
van Hooft 2008		<500 mls

Analysis 3.8

Comparison 3 Other Outcomes, Outcome 8 Blood Loss.

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Study	Blocked stents	Successful stents
Cheung 2009	0	20
Fiori 2004	0	11
Sankararajah 2005	0	7
van Hooft 2008	2	9
van Hooft 2011	0	47

Analysis 3.9

Comparison 3 Other Outcomes, Outcome 9 Stent Obstruction/Blockage.

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Summary of findings for the main comparison. Summary of outcomes

Outcome	No. of Study	No. of Participants	Statistical Mehtod	Effect Size
Clinical Success	3	168	Odds Ratio (M‐H, Fixed, 95% CI)	0.06 [0.01, 0.32]
30 Day Mortality	5	207	Odds Ratio (M‐H, Fixed, 95% CI)	1.41 [0.48, 4.14]
Complication	5	207	Odds Ratio (M‐H, Fixed, 95% CI)	0.79 [0.47, 1.34]
Major Wound Complications	2	146	Odds Ratio (M‐H, Fixed, 95% CI)	0.54 [0.05, 6.16]

Summary of findings for the main comparison. Summary of outcomes

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Comparison 1. Clinical Relief ‐ Colonic stent Vs Emergency surgery

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clinical Relief of Obstruction ‐ Numbers Show forest plot	3	168	Odds Ratio (M‐H, Fixed, 95% CI)	0.06 [0.01, 0.32]

2 Clinical Relief of Obstruction ‐ Time Show forest plot			Other data	No numeric data

Comparison 1. Clinical Relief ‐ Colonic stent Vs Emergency surgery

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Comparison 2. Technical Success ‐ Colonic Stent

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Technical Success Rates ‐ Colonic Stent Show forest plot			Other data	No numeric data

Comparison 2. Technical Success ‐ Colonic Stent

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Comparison 3. Other Outcomes

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 30 Day Mortality Show forest plot	5	207	Odds Ratio (M‐H, Fixed, 95% CI)	1.41 [0.48, 4.14]

2 Stent Related Perforation Show forest plot			Other data	No numeric data

3 Complications Show forest plot	5	207	Odds Ratio (M‐H, Fixed, 95% CI)	0.79 [0.47, 1.34]

4 Major Wound Complication Show forest plot	2	146	Odds Ratio (M‐H, Random, 95% CI)	0.54 [0.05, 6.16]

5 Stent Migration Show forest plot			Other data	No numeric data

6 Hospital Stay Show forest plot			Other data	No numeric data

7 Procedure/Operating Time Show forest plot			Other data	No numeric data

8 Blood Loss Show forest plot			Other data	No numeric data

9 Stent Obstruction/Blockage Show forest plot			Other data	No numeric data

Comparison 3. Other Outcomes

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