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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(07): E944-E952
DOI: 10.1055/a-1164-6398
Review

Clinical efficacy and safety of palliative esophageal stenting without fluoroscopy: a systematic review and meta-analysis

Saurabh Chandan‡
1   Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Babu P. Mohan‡
2   Internal Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona, United States
,
Shahab R. Khan
2   Internal Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona, United States
,
Neil Bhogal
1   Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Andrew Canakis
3   Boston University Medical Center, Boston, Massachusetts, United States
,
Mohammad Bilal
5   Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
,
Amaninder S. Dhaliwal
1   Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Muhammad Aziz
6   Internal Medicine, University of Toledo, Ohio, United States
,
Harmeet S. Mashiana
1   Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Shailender Singh
1   Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Wade Lee-Smith
7   University Library, University of Toledo, Ohio, United States
,
Suresh Ponnada
4   Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, United States
,
Ishfaq Bhat
1   Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Douglas Pleskow
5   Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
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Abstract

Background and study aims Despite advances in curative treatments for esophageal cancer, many patients often present with advanced disease. Dysphagia resulting in significant weight loss and malnutrition leads to poor quality of life. Palliative esophageal stenting with self-expanding metal stents (SEMS) helps alleviate symptoms and prolongs survival. However, access to fluoroscopy may be limited at certain centers causing delay in patient care.

Methods We searched multiple databases from inception to November 2019 to identify studies evaluating the efficacy and safety of endoscopic palliative esophageal stenting and selected only those studies where fluoroscopic guidance was not used. Our primary aim was to calculate the overall technical as well as clinical success. Using meta-regression analysis, we also evaluated the effect of tumor location and obstruction length on overall technical and clinical success.

Results A total of 1778 patients from 17 studies were analyzed. A total of 2036 stents were placed without the aid of fluoroscopy. The pooled rate of technical success was 94.7 % (CI 89.9–97.3, PI 55–99; I2 = 85) and clinical success was 82.1 % (CI 67.1–91.2, PI 24–99; I2 = 87). Based on meta-regression analysis both the length of obstruction and tumor location did not have any statistically significant effect on technical and clinical success. The pooled rate of adverse events was 4.1 % (CI 2.4–7.2; I2 = 72) for stent migration, 8.1 % (CI 4.1–15.4; I2 = 89) for tumor overgrowth and 1.2 % (CI 0.7–2; I2 = 0) for perforation. The most frequent clinical adverse event was retro-sternal chest pain.

Conclusion Palliative esophageal stenting without fluoroscopy using SEMS is both safe and effective in patients with advanced esophageal cancer.

Supplementary material: Supplementary Fig. S1–4, Appendix A+B, Supplementary Table S1



Publication History

Received: 06 February 2020

Accepted: 30 March 2020

Article published online:
16 June 2020

© 2020. Owner and Copyright ©

© Georg Thieme Verlag KG
Stuttgart · New York

 

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