Role of self-expanding metal stents in patients with malignant colorectal obstruction: A systematic review and meta-analysis

doi:10.13105/wjma.v3.i6.232

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World Journal of Meta-Analysis

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Meta-Analysis

World J Meta-Anal. Dec 26, 2015; 3(6): 232-253
Published online Dec 26, 2015. doi: 10.13105/wjma.v3.i6.232

Role of self-expanding metal stents in patients with malignant colorectal obstruction: A systematic review and meta-analysis

Nirav Thosani, Subhas Banerjee, Vikesh Khanijow, Bhavana Rao, Priyanka Priyanka, Atilla Ertan, Sushovan Guha

Nirav Thosani, Subhas Banerjee, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94304, United States

Nirav Thosani, Vikesh Khanijow, Bhavana Rao, Priyanka Priyanka, Atilla Ertan, Sushovan Guha, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, the University of Texas Health Medical School at Houston, Houston, TX 77030, United States

Nirav Thosani, Priyanka Priyanka, Atilla Ertan, Sushovan Guha, Ertan Digestive Disease Center, Memorial Hermann Hospital-TMC, Houston, TX 77030, United States

Author contributions: Thosani N contributed to study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis; Banerjee S and Ertan A contributed to drafting of the manuscript; critical revision of the manuscript for important intellectual content; Banerjee S contributed to administrative, technical, or material support; study supervision; Khanijow V and Rao B contributed to acquisition of data; analysis and interpretation of data; drafting of the manuscript; Priyanka P contributed to statistical analysis; analysis and interpretation of data; drafting of the manuscript; Guha S contributed to study concept and design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; administrative, technical, or material support; study supervision.

Conflict-of-interest statement: No potential conflict of interest exists between authors.

Data sharing statement: Data for this study is publicly available.

Correspondence to: Nirav Thosani, MD, MHA, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, the University of Texas Health Medical School at Houston, 4.234 Medical School Building, 6431 Fannin Street, Houston, TX 77030, United States. nirav.thosani@uth.tmc.edu

Telephone: +1-713-5006686 Fax: +1-713-5006699

Received: April 30, 2015
Peer-review started: April 30, 2015
First decision: June 24, 2015
Revised: October 7, 2015
Accepted: November 3, 2015
Article in press: November 4, 2015
Published online: December 26, 2015
Processing time: 238 Days and 2.4 Hours

Abstract

AIM: To assess the safety and efficacy of self-expandable metal stents (SEMSs) for malignant colorectal obstruction.

METHODS: Data regarding technical success, clinical success, and procedure related complications were collected from included studies. DerSimonian-Laird random effects model was used to generate the overall outcome. Thirty international studies with a total of 2058 patients with malignant colorectal obstruction were included.

RESULTS: The technical and clinical success rates for SEMS placement were 94% (95%CI: 92-96) and 91% (95%CI: 88-93), respectively. Overall complication rate for SEMS was 23% (95%CI: 18-29). Stent migration 8% (95%CI: 6-10) and stent obstruction 8% (95%CI: 6-11) were the most common complications, followed by perforation 5% (95%CI: 4%-7%). Surgical or endoscopic re-interventions were needed in 14% (95%CI: 10-18) of patients. Endoscopic repeat stent placement was required in 8% (95%CI: 6-10), while surgical intervention was needed in 6% (95%CI: 4-8).

CONCLUSION: SEMS are effective when used as palliation or bridge to surgery for malignant colorectal obstruction with high technical and clinical success. About 14% of patients require repeat endoscopic or surgical intervention for stent failure or to manage stent related complications.

Keywords: Metal stent; Colorectal cancer; Colon cancer; Rectal cancer; Intestinal obstruction; Bowel obstruction; Malignant obstruction; Colonic obstruction

Core tip: The technical and clinical success rates for self-expandable metal stents (SEMSs) placement were 94% (95%CI: 92-96) and 91% (95%CI: 88-93), respectively. Overall complication rate for SEMS was 23% (95%CI: 18-29). Stent migration 8% (95%CI: 6-10) and stent obstruction 8% (95%CI: 6-11) were the most common complications, followed by perforation 5% (95%CI: 4%-7%). Surgical or endoscopic re-interventions were needed in 14% (95%CI: 10-18) of patients. Endoscopic repeat stent placement was required in 8% (95%CI: 6-10), while surgical intervention was needed in 6% (95%CI: 4-8). SEMS are effective when used as palliation or bridge to surgery for malignant colorectal obstruction with high technical and clinical success. About 14% of patients require repeat endoscopic or surgical intervention for stent failure or to manage stent related complications.