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Short-term outcomes of a self-expandable metallic stent as a bridge to surgery vs. a transanal decompression tube for malignant large-bowel obstruction: a meta-analysis

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Abstract

Purpose

Preoperative intestinal decompression, using either a self-expandable metallic stent (SEMS) as a bridge to surgery (BTS) or a transanal decompression tube (TDT), provides an alternative to emergency surgery for malignant large-bowel obstruction (MLBO). We conducted this meta-analysis to compare the short-term outcomes of SEMS placement as a BTS vs. TDT placement for MLBO.

Methods

We conducted a comprehensive electronic search of literature published up to March, 2018, to identify studies comparing the short-term outcomes of BTS vs. TDT. Decompression device-related and surgery-related variables were evaluated and a meta-analysis was performed using random-effects models to calculate odd ratios with 95% confidence intervals.

Results

We analyzed 14 nonrandomized studies with a collective total of 581 patients: 307 (52.8%) who underwent SEMS placement as a BTS and 274 (47.2%) who underwent TDT placement. The meta-analyses showed that the BTS strategy conferred significantly better technical and clinical success, helped to maintain quality of life by allowing free food intake and temporal discharge, promoted laparoscopic one-stage surgery without stoma creation, and had equivalent morbidity and mortality to TDT placement.

Conclusions

Although the long-term outcomes are as yet undetermined, the BTS strategy using SEMS placement could be a new standard of care for preoperative decompression to manage MLBO.

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Acknowledgements

We have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamagari, Inzai, Chiba, 270-1694, Japan

    Akihisa Matsuda, Satoshi Matsumoto, Nobuyuki Sakurazawa, Youichi Kawano, Kumiko Sekiguchi & Masao Miyashita

  2. Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo, Tokyo, 113-8603, Japan

    Takeshi Yamada, Takeshi Matsutani & Hiroshi Yoshida

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  1. Akihisa Matsuda
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Contributions

All authors are in agreement with the content of the manuscript. The authors’ contributions are as follows: study concept and design, AM and TY; acquisition of data, AM, YK, KS, and NS; analysis and interpretation of data, AM, SM, and TM; drafting of the manuscript, AM; study supervision, MM and HY.

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Correspondence to Akihisa Matsuda.

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Supplementary Fig. 1

. Flow chart of the selection of studies for inclusion in the meta-analysis (TIF 81 KB)

Supplementary Fig. 2

. Funnel plot depicting the distribution of the odds ratio for the studies in this meta-analysis on technical success (A) and clinical success (B) (TIF 55 KB)

Supplementary material 3 (TIF 52 KB)

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Matsuda, A., Yamada, T., Matsumoto, S. et al. Short-term outcomes of a self-expandable metallic stent as a bridge to surgery vs. a transanal decompression tube for malignant large-bowel obstruction: a meta-analysis. Surg Today 49, 728–737 (2019). https://doi.org/10.1007/s00595-019-01784-y

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