Skip to main content
Top
Published in: Digestive Diseases and Sciences 11/2010

01-11-2010 | Review

The Use of Self-Expanding Stents in Esophageal and Gastroesophageal Junction Cancer Palliation: A Meta-Analysis and Meta-Regression Analysis of Outcomes

Authors: George Sgourakis, Ines Gockel, Arnold Radtke, Georgia Dedemadi, Konstantinos Goumas, Sofia Mylona, Hauke Lang, Achilleas Tsiamis, Constantine Karaliotas

Published in: Digestive Diseases and Sciences | Issue 11/2010

Login to get access

Abstract

Background

The objective of this study was to examine the impact of self-expanding stents versus locoregional treatment modalities in the setting of esophageal cancer palliation.

Methods

The present meta-analysis pooled the effects of outcomes of 1,027 patients enrolled in 16 randomized controlled trials.

Results

The meta-analysis revealed an advantage to the use of stents compared to locoregional modality treatments with respect to the number of patients requiring reinterventions, although the latter treatment arm had a higher 1-year survival. No difference was observed between the use of the antireflux stents and conventional stents in relieving reflux. Previous chemoradiotherapy had no impact on complications, procedural deaths, and overall patient survival. Differences in outcomes among stents were minimal.

Conclusions

Conventional self-expanding stents and anti-reflux stents are equally effective. Although the risk difference for 1-year survival favoured locoregional palliative treatment modalities, the latter were associated with a higher number of patients requiring reintervention.
Literature
1.
go back to reference Tytgat GNJ, Bartelink H, Bernards R, et al. Cancer of the esophagus and gastric cardia: recent advances. Dis Esophagus. 2004;17:10–26.CrossRefPubMed Tytgat GNJ, Bartelink H, Bernards R, et al. Cancer of the esophagus and gastric cardia: recent advances. Dis Esophagus. 2004;17:10–26.CrossRefPubMed
2.
3.
go back to reference Laasch HU, Marriott A, Wilbraham L, et al. Effectiveness of open versus antireflux stents for palliation of distal esophageal carcinoma and prevention of symptomatic gastroesophageal reflux. Radiology. 2002;225:359–365.CrossRefPubMed Laasch HU, Marriott A, Wilbraham L, et al. Effectiveness of open versus antireflux stents for palliation of distal esophageal carcinoma and prevention of symptomatic gastroesophageal reflux. Radiology. 2002;225:359–365.CrossRefPubMed
4.
go back to reference Homs MY, Wahab PJ, Kuipers EJ, et al. Esophageal stents with antireflux valve for tumors of the distal esophagus and gastric cardia: a randomized trial. Gastrointest Endosc. 2004;60:695–702.CrossRefPubMed Homs MY, Wahab PJ, Kuipers EJ, et al. Esophageal stents with antireflux valve for tumors of the distal esophagus and gastric cardia: a randomized trial. Gastrointest Endosc. 2004;60:695–702.CrossRefPubMed
5.
go back to reference Shim CS, Jung IS, Cheon YK, et al. Management of malignant stricture of the oesophagus-gastric junction with a newly designed self-expanding metal stent with an antireflux mechanism. Endoscopy. 2005;37:335–339.CrossRefPubMed Shim CS, Jung IS, Cheon YK, et al. Management of malignant stricture of the oesophagus-gastric junction with a newly designed self-expanding metal stent with an antireflux mechanism. Endoscopy. 2005;37:335–339.CrossRefPubMed
6.
go back to reference Wenger U, Johnsson E, Arnelo U, et al. An antireflux stent versus conventional stents for palliation of distal esophageal or cardia cancer: a randomized clinical study. Surg Endosc. 2006;20:1675–1680.CrossRefPubMed Wenger U, Johnsson E, Arnelo U, et al. An antireflux stent versus conventional stents for palliation of distal esophageal or cardia cancer: a randomized clinical study. Surg Endosc. 2006;20:1675–1680.CrossRefPubMed
7.
go back to reference Power C, Byrne PJ, Lim K, et al. Superiority of anti-reflux stent compared with conventional stents in the palliative management of patients with cancer of the lower esophagus and esophago-gastric junction: results of a randomized clinical trial. Dis Esophagus. 2007;20:466–470.CrossRefPubMed Power C, Byrne PJ, Lim K, et al. Superiority of anti-reflux stent compared with conventional stents in the palliative management of patients with cancer of the lower esophagus and esophago-gastric junction: results of a randomized clinical trial. Dis Esophagus. 2007;20:466–470.CrossRefPubMed
8.
go back to reference Sabharwal T, Gulati MS, Fotiadis N, et al. Randomised comparison of the FerX Ella antireflux stent and the ultraflex stent: proton pump inhibitor combination for prevention of post-stent reflux in patients with esophageal carcinoma involving the esophago-gastric junction. J Gastroenterol Hepatol. 2008;23:723–728.CrossRefPubMed Sabharwal T, Gulati MS, Fotiadis N, et al. Randomised comparison of the FerX Ella antireflux stent and the ultraflex stent: proton pump inhibitor combination for prevention of post-stent reflux in patients with esophageal carcinoma involving the esophago-gastric junction. J Gastroenterol Hepatol. 2008;23:723–728.CrossRefPubMed
9.
go back to reference Conio M, Repici A, Battaglia G, et al. A randomized prospective comparison of self-expandable plastic stents and partially covered self-expandable metal stents in the palliation of malignant esophageal dysphagia. Am J Gastroenterol. 2007;102:2667–2677.CrossRefPubMed Conio M, Repici A, Battaglia G, et al. A randomized prospective comparison of self-expandable plastic stents and partially covered self-expandable metal stents in the palliation of malignant esophageal dysphagia. Am J Gastroenterol. 2007;102:2667–2677.CrossRefPubMed
10.
go back to reference Sabharwal T, Hamadi MS, Chui S, et al. A randomised prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma. Gut. 2003;52:922–926.CrossRefPubMed Sabharwal T, Hamadi MS, Chui S, et al. A randomised prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma. Gut. 2003;52:922–926.CrossRefPubMed
11.
go back to reference Siersema PD, Hop WC, van Blankestein M, et al. A comparison of 3 types of covered metal stents for the palliation of patients with dysphagia caused by esophagogastric carcinoma: a prospective, randomized study. Gastrointest Endosc. 2001;54:145–153.PubMed Siersema PD, Hop WC, van Blankestein M, et al. A comparison of 3 types of covered metal stents for the palliation of patients with dysphagia caused by esophagogastric carcinoma: a prospective, randomized study. Gastrointest Endosc. 2001;54:145–153.PubMed
12.
go back to reference Verschuur EML, Repici A, Kuipers EJ, et al. New design esophageal stents for the palliation of dysphagia from esophageal or gastric cardia cancer: a randomized trial. Am J Gastroenterol. 2008;103:304–312.CrossRefPubMed Verschuur EML, Repici A, Kuipers EJ, et al. New design esophageal stents for the palliation of dysphagia from esophageal or gastric cardia cancer: a randomized trial. Am J Gastroenterol. 2008;103:304–312.CrossRefPubMed
13.
go back to reference Adam A, Ellul J, Watkinson A, et al. Palliation of inoperable esophageal carcinoma: a prospective randomized trial of laser therapy and stent placement. Radiology. 1997;202:344–348.PubMed Adam A, Ellul J, Watkinson A, et al. Palliation of inoperable esophageal carcinoma: a prospective randomized trial of laser therapy and stent placement. Radiology. 1997;202:344–348.PubMed
14.
go back to reference Dallal HJ, Smith GD, Grieve DC, et al. A randomized trial of thermal ablative therapy versus expandable metal stents in the palliative treatment of patients with esophageal carcinoma. Gastrointest Endosc. 2001;54:549–557.CrossRefPubMed Dallal HJ, Smith GD, Grieve DC, et al. A randomized trial of thermal ablative therapy versus expandable metal stents in the palliative treatment of patients with esophageal carcinoma. Gastrointest Endosc. 2001;54:549–557.CrossRefPubMed
15.
go back to reference Bergquist H, Wenger U, Johnsson E, et al. Stent insertion or endoluminal brachytherapy as palliation of patients with advanced cancer of the esophagus and gastroesophageal junction. Results of a randomized, controlled clinical trial. Dis Esophagus. 2005;18(3):131–139.CrossRefPubMed Bergquist H, Wenger U, Johnsson E, et al. Stent insertion or endoluminal brachytherapy as palliation of patients with advanced cancer of the esophagus and gastroesophageal junction. Results of a randomized, controlled clinical trial. Dis Esophagus. 2005;18(3):131–139.CrossRefPubMed
16.
go back to reference Homs MY, Steyerberg EW, Eijkenboom WM, et al. Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet. 2004;364(9444):1497–1504.CrossRefPubMed Homs MY, Steyerberg EW, Eijkenboom WM, et al. Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet. 2004;364(9444):1497–1504.CrossRefPubMed
17.
go back to reference Königsrainer A, Riedmann B, De Vries A, et al. Expandable metal stents versus laser combined with radiotherapy for palliation of unrespectable esophageal cancer: a prospective randomized trial. Hepatogastroenterology. 2000;47(33):724–727.PubMed Königsrainer A, Riedmann B, De Vries A, et al. Expandable metal stents versus laser combined with radiotherapy for palliation of unrespectable esophageal cancer: a prospective randomized trial. Hepatogastroenterology. 2000;47(33):724–727.PubMed
18.
go back to reference Shenfine J, McNamee P, Steen N, et al. A pragmatic randomised controlled trial of the cost-effectiveness of palliative therapies for patients with inoperable oesophageal cancer. Health Technol Assess. 2005;9(5)1–121. Shenfine J, McNamee P, Steen N, et al. A pragmatic randomised controlled trial of the cost-effectiveness of palliative therapies for patients with inoperable oesophageal cancer. Health Technol Assess. 2005;9(5)1–121.
19.
go back to reference Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomized controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet. 1999;354:1896–1900.CrossRefPubMed Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomized controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet. 1999;354:1896–1900.CrossRefPubMed
20.
go back to reference Mahid SS, Hornung CA, Minor KS, et al. Systematic reviews and meta-analysis for the surgeon scientist. Br J Surg. 2006;93:1315–1324.CrossRefPubMed Mahid SS, Hornung CA, Minor KS, et al. Systematic reviews and meta-analysis for the surgeon scientist. Br J Surg. 2006;93:1315–1324.CrossRefPubMed
21.
go back to reference Egger M, Smith GD, Altman DG. Systematic Reviews in Health Care: Meta-Analysis in Context. 2nd ed. London: BMJ Books; 2001. Egger M, Smith GD, Altman DG. Systematic Reviews in Health Care: Meta-Analysis in Context. 2nd ed. London: BMJ Books; 2001.
22.
go back to reference Review Manager (RevMan) [Computer program]. Version 4.2 for Windows. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2003. Review Manager (RevMan) [Computer program]. Version 4.2 for Windows. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2003.
23.
go back to reference Higgins JPT, Green S, eds. Cochrane handbook for systematic reviews of interventions 4.2.6 [updated September 2006]. In: The Cochrane Library. Issue 4. Chichester, UK: Wiley; 2006. Higgins JPT, Green S, eds. Cochrane handbook for systematic reviews of interventions 4.2.6 [updated September 2006]. In: The Cochrane Library. Issue 4. Chichester, UK: Wiley; 2006.
24.
go back to reference Zamora J, Abraira V, Muriel A, Khan KS, Coomarasamy A. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol. 2006;6:31.CrossRefPubMed Zamora J, Abraira V, Muriel A, Khan KS, Coomarasamy A. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol. 2006;6:31.CrossRefPubMed
25.
go back to reference Rosenberg MS, Adams DC, Gurevitch J. MetaWin. Statistical software for meta-analysis. Version 2. Sunderland, MA: Sinauer Associates; 2000. Rosenberg MS, Adams DC, Gurevitch J. MetaWin. Statistical software for meta-analysis. Version 2. Sunderland, MA: Sinauer Associates; 2000.
26.
go back to reference Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.CrossRefPubMed Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.CrossRefPubMed
27.
go back to reference Moher D, Pham B, Jones A, et al. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet. 1998;352:609–613.CrossRefPubMed Moher D, Pham B, Jones A, et al. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet. 1998;352:609–613.CrossRefPubMed
28.
go back to reference Vakil N, Morris AI, Marcon N, et al. A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction. Am J Gastroenterol. 2001;96:1791–1796.CrossRefPubMed Vakil N, Morris AI, Marcon N, et al. A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction. Am J Gastroenterol. 2001;96:1791–1796.CrossRefPubMed
29.
go back to reference Lightdale CJ, Heier SK, Marcon NE, et al. Photodynamic therapy with porfimer sodium versus thermal ablation therapy with Nd:YAG laser for palliation of esophageal cancer: a multicenter randomized trial. Gastrointest Endosc. 1995;42:507–512.CrossRefPubMed Lightdale CJ, Heier SK, Marcon NE, et al. Photodynamic therapy with porfimer sodium versus thermal ablation therapy with Nd:YAG laser for palliation of esophageal cancer: a multicenter randomized trial. Gastrointest Endosc. 1995;42:507–512.CrossRefPubMed
30.
go back to reference Ilson DH, Bains M, Kelsen DP, et al. Phase I trial of escalating-dose irinotecan given weekly with cisplatin and concurrent radiotherapy in locally advanced esophageal cancer. J Clin Oncol. 2003;21(15):2926–2932.CrossRefPubMed Ilson DH, Bains M, Kelsen DP, et al. Phase I trial of escalating-dose irinotecan given weekly with cisplatin and concurrent radiotherapy in locally advanced esophageal cancer. J Clin Oncol. 2003;21(15):2926–2932.CrossRefPubMed
31.
go back to reference Tebbutt NC, Norman A, Cunningham D, et al. A multicentre, randomised phase III trial comparing protracted venous infusion (PVI) 5-fluorouracil (5-FU) with PVI 5-FU plus mitomycin C in patients with inoperable oesophago-gastric cancer. Ann Oncol. 2002;13(10):1568–1575.CrossRefPubMed Tebbutt NC, Norman A, Cunningham D, et al. A multicentre, randomised phase III trial comparing protracted venous infusion (PVI) 5-fluorouracil (5-FU) with PVI 5-FU plus mitomycin C in patients with inoperable oesophago-gastric cancer. Ann Oncol. 2002;13(10):1568–1575.CrossRefPubMed
32.
go back to reference Vyhnálek P, Hájek J, Havlícek K, et al. Comparison of coated and bare metallic stents in inoperable carcinomas of the oesophagus and cardia. Rozhl Chir. 2006;85(7):323–328.PubMed Vyhnálek P, Hájek J, Havlícek K, et al. Comparison of coated and bare metallic stents in inoperable carcinomas of the oesophagus and cardia. Rozhl Chir. 2006;85(7):323–328.PubMed
33.
go back to reference Homs MY, Steyerberg EW, Eijkenboom WM, et al. Palliative treatment of esophageal cancer with dysphagia: more favourable outcome from single-dose internal brachytherapy than from the placement of a self-expanding stent; a multicenter randomised study. Ned Tijdschr Geneeskd. 2005;149(50):2800–2806.PubMed Homs MY, Steyerberg EW, Eijkenboom WM, et al. Palliative treatment of esophageal cancer with dysphagia: more favourable outcome from single-dose internal brachytherapy than from the placement of a self-expanding stent; a multicenter randomised study. Ned Tijdschr Geneeskd. 2005;149(50):2800–2806.PubMed
34.
go back to reference Nicholson DA, Haycox A, Kay CL, et al. The cost effectiveness of metal oesophageal stenting in malignant disease compared with conventional therapy. Clin Radiol. 1999;54:212–215.CrossRefPubMed Nicholson DA, Haycox A, Kay CL, et al. The cost effectiveness of metal oesophageal stenting in malignant disease compared with conventional therapy. Clin Radiol. 1999;54:212–215.CrossRefPubMed
35.
go back to reference Wenger U, Johnsson E, Bergquist H, et al. Health economic evaluation of stent or endoluminal brachytherapy as a palliative strategy in patients with incurable cancer of the oesophagus or gastro-oesophageal junction: results of a randomized clinical trial. Eur J Gastroenterol Hepatol. 2005;17(12):1369–1377.CrossRefPubMed Wenger U, Johnsson E, Bergquist H, et al. Health economic evaluation of stent or endoluminal brachytherapy as a palliative strategy in patients with incurable cancer of the oesophagus or gastro-oesophageal junction: results of a randomized clinical trial. Eur J Gastroenterol Hepatol. 2005;17(12):1369–1377.CrossRefPubMed
36.
go back to reference Brown SG. Palliative modalities for treatment of advanced esophageal cancer; ablative therapies. In: Proceedings Cancer of Esophagus and Gastric Cardia: From Gene to Cure. Amsterdam: European Cancer Centre; 2002 (abstract S52). Brown SG. Palliative modalities for treatment of advanced esophageal cancer; ablative therapies. In: Proceedings Cancer of Esophagus and Gastric Cardia: From Gene to Cure. Amsterdam: European Cancer Centre; 2002 (abstract S52).
Metadata
Title
The Use of Self-Expanding Stents in Esophageal and Gastroesophageal Junction Cancer Palliation: A Meta-Analysis and Meta-Regression Analysis of Outcomes
Authors
George Sgourakis
Ines Gockel
Arnold Radtke
Georgia Dedemadi
Konstantinos Goumas
Sofia Mylona
Hauke Lang
Achilleas Tsiamis
Constantine Karaliotas
Publication date
01-11-2010
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 11/2010
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-010-1250-1

Other articles of this Issue 11/2010

Digestive Diseases and Sciences 11/2010 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.