Meta-Analysis
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2016; 22(34): 7841-7850
Published online Sep 14, 2016. doi: 10.3748/wjg.v22.i34.7841
Double-layered covered stent for the treatment of malignant oesophageal obstructions: Systematic review and meta-analysis
Zeiad Hussain, Athanasios Diamantopoulos, Miltiadis Krokidis, Konstantinos Katsanos
Zeiad Hussain, Athanasios Diamantopoulos, Konstantinos Katsanos, Department of Interventional Radiology, Guy’s and St.Thomas’ Hospitals, NHS Foundation Trust, London SE1 7EH, United Kingdom
Miltiadis Krokidis, Department of Interventional Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
Author contributions: Diamantopoulos A, Krokidis M and Katsanos K designed the systematic review; Hussain Z collected the data; Katsanos K analysed data; Hussain Z and Diamantopoulos A wrote the paper; and Katsanos K revised the paper.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Konstantinos Katsanos, MSc, MD, PhD, EBIR, Consultant Vascular and Interventional Radiology, Department of Interventional Radiology, Guy’s and St.Thomas’ Hospitals, NHS Foundation Trust, King’s Health Partners, London SE1 7EH, United Kingdom. konstantinos.katsanos@gstt.nhs.uk
Telephone: +44-207-1885550 Fax: +44-207-9288071
Received: March 28, 2016
Peer-review started: March 29, 2016
First decision: May 27, 2016
Revised: July 2, 2016
Accepted: August 1, 2016
Article in press: August 1, 2016
Published online: September 14, 2016
Processing time: 165 Days and 1 Hours
Abstract
AIM

To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal obstructions.

METHODS

A systematic review and meta-analysis was performed following the PRISMA process. PubMed (Medline), EMBASE (Excerpta Medical Database), AMED (Allied and Complementary medicine Database), Scopus and online content, were searched for studies reporting on the NiTi-S polyurethane-covered double oesophageal stent for the treatment of malignant dysphagia. Weighted pooled outcomes were synthesized with a random effects model to account for clinical heterogeneity. All studies reporting the outcome of palliative management of dysphagia due to histologically confirmed malignant oesophageal obstruction using double-layered covered nitinol stent were included. The level of statistical significance was set at α = 0.05.

RESULTS

Six clinical studies comprising 250 patients in total were identified. Pooled technical success of stent insertion was 97.2% (95%CI: 94.8%-98.9%; I2 = 5.8%). Pooled complication rate was 27.6% (95%CI: 20.7%-35.2%; I2 = 41.9%). Weighted improvement of dysphagia on a scale of 0-5 scoring system was -2.00 [95%CI: -2.29%-(-1.72%); I2 = 87%]. Distal stent migration was documented in 10 out of the 250 cases examined. Pooled stent migration rate was 4.7% (95%CI: 2.5%-7.7%; I2 = 0%). Finally, tumour overgrowth was reported in 34 out of the 250 cases with pooled rate of tumour overgrowth of 11.2% (95%CI: 3.7%-22.1%; I2 = 82.2%). No funnel plot asymmetry to suggest publication bias (bias = 0.39, P = 0.78). In the sensitivity analysis all results were largely similar between the fixed and random effects models.

CONCLUSION

The double-layered nitinol stent provides immediate relief of malignant dysphagia with low rates of stent migration and tumour overgrowth

Keywords: Double-layered covered stent; Malignant oesophageal obstructions; Dysphagia; Double-layered nitinol stent

Core tip: The aim of this systematic review and meta-analysis is to investigate the efficacy of double-layered nitinol covered stent in the treatment of malignant oesophageal obstructions. The literature was searched following the PRISMA selection process as recommended by Cochrane. Weighted pooled outcomes were synthesized with a random effects model to account for clinical heterogeneity. This meta-analysis highlights the promising outcomes of the double-layered covered stent and demonstrates significant immediate relief of dysphagia with low rates of stent migration and tumour overgrowth. The unique design of this stent seems to combines the merits of both plain covered and uncovered metal esophageal stent designs.