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

Apostolis Papaefthymiou; Paraskevas Gkolfakis; Kirill Basiliya; Daryl Ramai; Georgios Tziatzios; Vinay Sehgal; Andrea Telese; Benjamin Norton; Nasar Aslam; Gavin Johnson; Rehan Haidry

doi:10.1055/a-2147-8294

Endoscopy, Table of Contents

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

¹Endoscopy Unit, University College London Hospitals, London, United Kingdom

,

Paraskevas Gkolfakis

²Department of Gastroenterology, General Hospital of Nea Ionia “Konstantopoulio-Patision”, Athens, Greece

³Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium

,

Kirill Basiliya

¹Endoscopy Unit, University College London Hospitals, London, United Kingdom

,

Daryl Ramai

⁴Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, United States

,

Georgios Tziatzios

²Department of Gastroenterology, General Hospital of Nea Ionia “Konstantopoulio-Patision”, Athens, Greece

,

Vinay Sehgal

¹Endoscopy Unit, University College London Hospitals, London, United Kingdom

,

Andrea Telese

¹Endoscopy Unit, University College London Hospitals, London, United Kingdom

,

Benjamin Norton

¹Endoscopy Unit, University College London Hospitals, London, United Kingdom

,

Nasar Aslam

¹Endoscopy Unit, University College London Hospitals, London, United Kingdom

,

Gavin Johnson

¹Endoscopy Unit, University College London Hospitals, London, United Kingdom

,

Rehan Haidry

¹Endoscopy Unit, University College London Hospitals, London, United Kingdom

⁵Cleveland Clinic London, London, United Kingdom

› Author Affiliations

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.

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