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Endoscopy 2024; 56(01): 22-30
DOI: 10.1055/a-2147-8294
Systematic review

Success rates of fixation techniques on prevention of esophageal stent migration: a systematic review and meta-analysis

Apostolis Papaefthymiou 
1   Endoscopy Unit, University College London Hospitals, London, United Kingdom
,
Paraskevas Gkolfakis
2   Department of Gastroenterology, General Hospital of Nea Ionia “Konstantopoulio-Patision”, Athens, Greece
3   Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
,
Kirill Basiliya
1   Endoscopy Unit, University College London Hospitals, London, United Kingdom
,
Daryl Ramai
4   Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, United States
,
Georgios Tziatzios 
2   Department of Gastroenterology, General Hospital of Nea Ionia “Konstantopoulio-Patision”, Athens, Greece
,
Vinay Sehgal
1   Endoscopy Unit, University College London Hospitals, London, United Kingdom
,
Andrea Telese
1   Endoscopy Unit, University College London Hospitals, London, United Kingdom
,
Benjamin Norton 
1   Endoscopy Unit, University College London Hospitals, London, United Kingdom
,
Nasar Aslam
1   Endoscopy Unit, University College London Hospitals, London, United Kingdom
,
Gavin Johnson
1   Endoscopy Unit, University College London Hospitals, London, United Kingdom
,
Rehan Haidry
1   Endoscopy Unit, University College London Hospitals, London, United Kingdom
5   Cleveland Clinic London, London, United Kingdom
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Abstract

Background Esophageal stenting is an important intervention for managing malignant and benign dysphagia, with stent migration representing a common drawback. This systematic review with meta-analysis aimed to assess the benefit of stent fixation over nonfixation.

Methods A systematic search was performed in MEDLINE, Cochrane, Scopus, and ClinicalTrials.gov databases until January 2023 for comparative studies evaluating the migration rates of esophageal stents with versus without (control) fixation. The primary outcome was migration rate. Secondary outcomes included adverse event rate. A subgroup analysis stratified the results based on different fixation techniques: suturing, over-the-scope (OTS) clipping, and through-the-scope (TTS) clipping. Meta-analysis was based on a random effects model and the results were reported as odds ratios (ORs) with 95 %CIs.

Results 10 studies (1014 patients) were included. The rate of stent migration was significantly lower after fixation (OR 0.20, 95 %CI 0.11–0.37; I2  = 59 %, P = 0.01). The adverse event rate was similar between fixation and control groups (OR 0.65, 95 %CI 0.28–1.52; I2  = 55 %, P = 0.06). In the subgroup analysis, all fixation techniques remained superior to nonfixation of stents (suturing OR 0.23, 95 %CI 0.10–0.53; OTS clips OR 0.31, 95 %CI 0.17–0.58; TTS clips OR 0.10, 95 %CI 0.03–0.38); however, only the OTS and TTS clip groups achieved nonsignificant heterogeneity (I2  = 0 %, P = 0.67 and P = 0.73, respectively). No difference between techniques was recorded for migration rates.

Conclusion Esophageal stent fixation was associated with significantly lower migration rates compared with nonfixation of stents, regardless of fixation technique and stenting indication.

Tables 1 s, 2 s, Figs. 1 s–5 s



Publication History

Received: 31 March 2023

Accepted after revision: 03 August 2023

Accepted Manuscript online:
03 August 2023

Article published online:
14 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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