Clinical outcomes following stent placement in refractory benign esophageal stricture: a systematic review and meta-analysis

Lorenzo Fuccio; Cesare Hassan; Leonardo Frazzoni; Rossella Miglio; Alessandro Repici

doi:10.1055/s-0034-1393331

Endoscopy, Table of Contents

Endoscopy 2016; 48(02): 141-148
DOI: 10.1055/s-0034-1393331

Original article

Clinical outcomes following stent placement in refractory benign esophageal stricture: a systematic review and meta-analysis

Lorenzo Fuccio

¹Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

,

Cesare Hassan

²Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy

,

Leonardo Frazzoni

¹Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

,

Rossella Miglio

³Department of Statistical Sciences “Paolo Fortunati”, University of Bologna, Bologna, Italy

,

Alessandro Repici

⁴Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano (MI), Italy

› Author Affiliations

Abstract

Background and aims: The management of refractory benign esophageal strictures (RBESs) is challenging. Stent placement has been proposed as a possible rescue strategy. We performed a systematic review and meta-analysis to examine the efficacy of this strategy in the long-term resolution of dysphagia.

Methods: PubMed, SCOPUS, and Google Scholar were searched (up to January 2015). Studies recruiting adults with RBES treated with stent placement were eligible. The success, adverse event, and migration rates were pooled by means of a random-effect model to obtain odds with a 95 % confidence interval (CI).

Results: Eighteen studies (444 patients) were eligible for inclusion. The pooled clinical success rate was 40.5 % (95 %CI 31.5 % – 49.5 %), yielding odds of 0.68 (95 %CI 0.46 – 0.98) with high heterogeneity (I² = 65.0 %). The meta-regression analysis showed stricture etiology as the only influencing factor. Treatment with self-expanding plastic (SEPSs) and metal stents (SEMSs) did not result in significantly higher success rates than treatment with biodegradable stents (BDSs) (46.2 % vs. 40.1 % vs. 32.9 %, respectively). The migration rate was 28.6 % (95 %CI 21.9 % – 37.1 %), yielding odds of 0.40 (95 %CI 0.28 – 0.59), with migration rates for SEPSs and SEMSs reported as being not significantly higher than BDSs (33.3 % vs. 31.5 % vs. 15.3 %, respectively). The adverse event rate was 20.6 % (95 %CI 15.3 % – 28.1 %), yielding odds of 0.26 (95 %CI 0.18 – 0.39) with no significant difference between stent types (19.4 % vs. 21.9 % vs. 21.9 %, respectively).

Conclusions: Stent placement in patients with RBES is effective in about 40 % of cases. Further studies should investigate whether the clinical success rate varies according to the stricture etiology.

(PROSPERO registration number: CRD42015019017.)

Full Text

References

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