Clinical outcomes of self-expandable stent placementfor benign esophageal diseases： A pooled analysis of theliterature

• 作者: Emo E van Halsema Jeanin E van Hooft
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: Self-expandable STENTS BENIGN esophagealstrictures ESOPHAGEAL perforation ESOPHAGEAL FISTULA Anastomotic leak Systematic review
• 年，卷（期）: 2015,（2）
• 页码范围: 135-153
• 页数: 19页
• 分类号: R

摘要

AIM： To analyze the outcomes of self-expandable stentplacement for benign esophageal strictures and benignesophageal leaks in the literature.METHODS： The PubMed, Embase and Cochranedatabases were searched for relevant articles publishedbetween January 2000 and July 2014. Eight prospectivestudies were identified that analyzed the outcomesof stent placement for refractory benign esophagealstrictures. The outcomes of stent placement forbenign esophageal leaks, perforations and fistulaewere extracted from 20 retrospective studies thatwere published after the inclusion period of a recentsystematic review. Data were pooled and analyzedusing 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 benignesophageal strictures. The overall clinical success ratewas 24.2% and according to stent type 14.1% forFC SEMS, 32.9% for BD stents and 27.1% for SEPS.Stent migration occurred in 24.6% of cases. Theoverall complication rate was 31.0%, including major（17.7%） and minor （13.4%） complications. A total of643 patients were treated with self-expandable stentsmainly for postsurgical leaks （64.5%）, iatrogenicperforations （19.6%）, Boerhaave＇s syndrome （7.8%）and fistulae （3.7%）. FC SEMS and partially coveredSEMS were used in the majority of patients. Successfulclosure of the defect was achieved in 76.8% ofpatients and according to etiology in 81.4% forpostsurgical leaks, 86.0% for perforations and 64.7%for fistulae. The pooled stent migration rate was16.5%. Stent-related complications occurred in 13.4%of patients, including major （7.8%） and minor （5.5%）complications.CONCLUSION： The outcomes of stent placementfor refractory benign esophageal strictures were poor.However, randomized trials are needed to put thisinto perspective. The evidence on successful stentplacement for benign esophageal leaks, perfor