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Surgical Endoscopy

Published in:

01-02-2018

Stent migration following endoscopic suture fixation of esophageal self-expandable metal stents: a systematic review and meta-analysis

Authors: Ryan Law, Anoop Prabhu, Larissa Fujii-Lau, Carol Shannon, Siddharth Singh

Published in: Surgical Endoscopy | Issue 2/2018

Abstract

Background

Covered self-expandable metal stents (SEMS) are utilized for the management of benign and malignant esophageal conditions; however, covered SEMS are prone to migration. Endoscopic suture fixation may mitigate the migration risk of covered esophageal SEMS. Hence, we conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of endoscopic suture fixation for covered esophageal SEMS.

Methods

Following PRISMA guidelines, we performed a systematic review from 2011 to 2016 to identify studies (case control/case series) reporting the technical success and migration rate of covered esophageal SEMS following endoscopic suture fixation. We searched multiple electronic databases and conference proceedings. We calculated pooled rates (and 95% confidence intervals [CI]) of technical success and stent migration using a random effects model.

Results

We identified 14 studies (212 patients) describing covered esophageal SEMS placement with endoscopic suture fixation. When reported, SEMS indications included leak/fistula (n = 75), stricture (n = 65), perforation (n = 10), and achalasia (n = 4). The pooled technical success rate was 96.7% (95% CI 92.3–98.6), without heterogeneity (I ² = 0%). We identified 29 SEMS migrations at rate of 15.9% (95% CI 11.4–21.6), without heterogeneity (I ² = 0%). Publication bias was observed, and using the trim-and-fill method, a more conservative estimate for stent migration was 17.0%. Suture-related adverse events were estimated to occur in 3.7% (95% CI 1.6–8.2) of cases.

Conclusions

Endoscopic suture fixation of covered esophageal SEMS appears to reduce stent migration when compared to published rates of non-anchored SEMS. However, SEMS migration still occurs in approximately 1 out of 6 cases despite excellent immediate technical success and low risk of suture-related adverse events.

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Title: Stent migration following endoscopic suture fixation of esophageal self-expandable metal stents: a systematic review and meta-analysis
Authors: Ryan Law
Anoop Prabhu
Larissa Fujii-Lau
Carol Shannon
Siddharth Singh
Publication date: 01-02-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 2/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5720-9

At a glance: The STEP trials

Springer Medicine

Stent migration following endoscopic suture fixation of esophageal self-expandable metal stents: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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