ANTI-REFLUX VERSUS CONVENTIONAL SELF-EXPANDING METAL STENTS (SEMS) IN THE PALLIATION OF ADVANCED ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

Aims Conventional self-expanding metal stents (SEMS-NV) are an effective palliative therapy to reduce dysphagia and improve the patient’s nutritional status. Gastroesophageal reflux disease (GERD) is a common adverse event after the use of SEMS, and it has been proposed that valved SEMS (SEMS-V) could improve the quality of life of patients. This is a systematic review and meta-analysis that includes only randomized clinical trials (RCTs) and that aimed at comparing SEMS-V versus SEMS-NV in the palliation of advanced esophageal cancer.

Methods A comprehensive search of multiple electronic databases to identify RCTs comparing SEMS-V and SEMS-NV was performed following the PRISMA guidelines. The risk of bias was assessed by RoB 2 tool, data were analyzed with Comprehensive Meta-Analysis V5.4, and quality of evidence by GRADE.

Results Ten RCTs evaluating a total of 467 patients, with 234 in the intervention group (SEMS-V) and 233 in the comparison group (SEMS-NV). There were no statistically significant differences in post-procedure dysphagia (RD -0.07; 95% CI -0.19, 0.06; p=0.30; I²=0%), post-procedural complications (RD 0.07; 95% CI -0.07, 0.20; p=0.32; I²=59%), or technical success (RD -0.03; 95% CI -0.07, 0.01; p=0.16; I²=0%). Regarding stent migration, no significant difference was identified (RD 0.07; 95% CI -0.02, 0.15; p=0.11; I²=0%).

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Conclusions SEMS-V and SEMS-NV are both safe and effective therapies in the palliation of advanced esophageal cancer. Our study grouped SEMS-V with different anti-reflux mechanisms and therefore future clinical trials are warranted to evaluate potential differences in GERD between different mechanisms.

Publication History

Article published online:
14 April 2022