Endoscopy 2011; 43(5): 386-393
DOI: 10.1055/s-0030-1256331
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Esophageal stents for benign refractory strictures: a meta-analysis

T.  Thomas1 , K.  R.  Abrams2 , V.  Subramanian3 , J.  Mannath3 , K.  Ragunath3
  • 1Northampton General Hospital, Cliftonville Road, Northampton, United Kingdom
  • 2Department of Health Sciences and Statistics, University of Leicester, University Road, Leicester, United Kingdom
  • 3Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit, Queen’s Medical Centre Campus, Derby Road, Nottingham, United Kingdom
Further Information

Publication History

submitted 1 May 2010

accepted after revision 10 December 2010

Publication Date:
24 March 2011 (online)

Background and aims: Fully covered self-expanding removable stents (SERS) have been considered a viable alternative to serial bougienage. The primary aim of this meta-analysis was to determine the efficacy of SERS for refractory esophageal strictures.

Methods: Medline, Embase, and PubMed databases were searched using the keywords ”esophageal stricture,” ”esophageal stents,” ”benign stricture,” ”dysphagia,” ”caustic,” ”peptic stricture,” ”anastomotic,” ”radiation,” and ”dysphagia” for the period from January 1965 to June 2010. Articles were selected for review independently by two authors (T. T. and J. M.) on the basis of predefined inclusion criteria, and the data collected. A meta-analysis using a random effects model was done.

Results: Eight studies with a total of 199 patients were included in the final analysis (104-males, average age 56 years, range: 49 – 68 years). Overall, 46.2 % of patients (95 %CI: 38.3 % – 54.1 %) had dysphagia improvement at an average follow up of 74 weeks. There was a significant difference (P = 0.019) in dysphagia improvement for patients with Polyflex stents (55.3 %; 95 %CI: 44.4 % – 65.9 %) versus nitinol stents (21.8 %; 95 %CI: 13.7 % – 33.7 %). On meta-regression, patient sex (P = 0.80), patient age (P = 0.725), corrosive etiology (P = 0.30), stricture location (P = 0.273), stricture length (P = 0.32), time of removal (P = 0.056), and duration of follow-up (0.35) had no significance influence on the outcome. The migration rate was 26.4 % (95 %CI: 25.3 % – 39.3 %).

Conclusions: Although the efficacy of SERS placement in benign refractory strictures is 46.2 %, it is associated with migration rate of 26.4 %. Nevertheless, the use of these temporary stents, which can be successfully removed in 87 % of patients, is an alluring prospect for treating patients with this difficult condition.

References

K. Ragunath, MD, FRCP (Lond) 

Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit
Queens Medical Centre Campus

Derby Road
Nottingham
NG27 2UH
United Kingdom

Email: k.ragunath@nottingham.ac.uk