Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2015; 7(2): 135-153
Published online Feb 16, 2015. doi: 10.4253/wjge.v7.i2.135
Clinical outcomes of self-expandable stent placement for benign esophageal diseases: A pooled analysis of the literature
Emo E van Halsema, Jeanin E van Hooft
Emo E van Halsema, Jeanin E van Hooft, Department of Gastroenterology and Hepatology, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
Author contributions: van Halsema EE and van Hooft JE contributed to conception and design, analysis and interpretation of the data, drafting of the article and final approval of the article; van Hooft JE contributed to critical revision of the article.
Conflict-of-interest: Emo van Halsema had no conflict of interest. Jeanin van Hooft: consultancy work for Cook Medical, Boston Scientific, Abbott and Covidien.
Data sharing: All data in this systematic review were extracted from the original articles and are presented in the literature Tables 1 and 4. 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: Jeanin E van Hooft, MD, PhD, Department of Gastroenterology and Hepatology, C2-116, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. j.e.vanhooft@amc.uva.nl
Telephone: +31-20-5667918 Fax: +31-20-6917033
Received: August 28, 2014
Peer-review started: September 3, 2014
First decision: November 19, 2014
Revised: December 4, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: February 16, 2015
Processing time: 167 Days and 11 Hours
Abstract

AIM: To analyze the outcomes of self-expandable stent placement for benign esophageal strictures and benign esophageal leaks in the literature.

METHODS: The PubMed, Embase and Cochrane databases were searched for relevant articles published between January 2000 and July 2014. Eight prospective studies were identified that analyzed the outcomes of stent placement for refractory benign esophageal strictures. The outcomes of stent placement for benign esophageal leaks, perforations and fistulae were extracted from 20 retrospective studies that were published after the inclusion period of a recent systematic review. Data were pooled and analyzed using descriptive statistics.

RESULTS: Fully covered self-expandable metal stents (FC SEMS) (n = 85), biodegradable (BD) stents (n = 77) and self-expandable plastic stents (SEPS) (n = 70) were inserted in 232 patients with refractory benign esophageal strictures. The overall clinical success rate was 24.2% and according to stent type 14.1% for FC SEMS, 32.9% for BD stents and 27.1% for SEPS. Stent migration occurred in 24.6% of cases. The overall complication rate was 31.0%, including major (17.7%) and minor (13.4%) complications. A total of 643 patients were treated with self-expandable stents mainly for postsurgical leaks (64.5%), iatrogenic perforations (19.6%), Boerhaave’s syndrome (7.8%) and fistulae (3.7%). FC SEMS and partially covered SEMS were used in the majority of patients. Successful closure of the defect was achieved in 76.8% of patients and according to etiology in 81.4% for postsurgical leaks, 86.0% for perforations and 64.7% for fistulae. The pooled stent migration rate was 16.5%. Stent-related complications occurred in 13.4% of patients, including major (7.8%) and minor (5.5%) complications.

CONCLUSION: The outcomes of stent placement for refractory benign esophageal strictures were poor. However, randomized trials are needed to put this into perspective. The evidence on successful stent placement for benign esophageal leaks, perforations and fistulae is promising.

Keywords: Self-expandable stents; Benign esophageal strictures; Esophageal perforation; Esophageal fistula; Anastomotic leak; Systematic review

Core tip: After a systematic search of the literature, we performed a pooled analysis on the clinical outcomes of self-expandable stent placement for benign esophageal diseases. We analyzed the clinical success, adverse events and removal outcome of stent placement in 232 patients with refractory benign esophageal strictures and 643 patients with benign esophageal leaks, perforations and fistulae. Additional analyses were performed for clinical outcomes according to stent type and etiology.