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

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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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Abbreviations

SEMS:

Self-expandable metal stents

PC-SEMS:

Partially covered self-expandable metal stents

FC-SEMS:

Fully covered self-expandable metal stents

TTS:

Through-the-scope

OTS:

Over-the-scope

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

SEPS:

Self-expandable plastic stent

CI:

Confidence interval

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Authors and Affiliations

Authors

Contributions

RL: Conception of article, drafting of the manuscript, final manuscript approval. AP, LF-L: Critical review, literature review, final manuscript approval. CS: Literature search, drafting of the manuscript. SS: Critical review, statistical analysis.

Corresponding author

Correspondence to Ryan Law.

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Disclosures

Ryan Law, Anoop Prabhu, Larissa Fujii-Lau, Carol Shannon, and Siddharth Singh have no conflicts of interest or financial ties to disclose.

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Law, R., Prabhu, A., Fujii-Lau, L. et al. Stent migration following endoscopic suture fixation of esophageal self-expandable metal stents: a systematic review and meta-analysis. Surg Endosc 32, 675–681 (2018). https://doi.org/10.1007/s00464-017-5720-9

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  • DOI: https://doi.org/10.1007/s00464-017-5720-9

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