Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2019; 11(4): 271-280
Published online Apr 16, 2019. doi: 10.4253/wjge.v11.i4.271
Efficacy and safety of standard and anti-reflux self-expanding metal stent: A systematic review and meta-analysis of randomized controlled trials
Sudha Pandit, Hrishikesh Samant, James Morris, Steven J Alexander
Sudha Pandit, Hrishikesh Samant, James Morris, Department of Gastroenterology and Hepatology, Louisiana State University Health Science Center, Shreveport, LA 71103, United States
Steven J Alexander, Department of Cell Biology and Physiology, Louisiana State University, School of Medicine, Shreveport, LA 71103, United States
Author contributions: Pandit S and Samant H contributed equally to prepare this manuscript. Pandit S and Samant H designed study, performed data acquisition, analyzed data, drafted manuscript, final approval; Morris J analyzed data, edited manuscript; Alexander S edited manuscript, final approval.
Conflict-of-interest statement: The authors have no conflicting financial interests to disclose.
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/
Corresponding author: Sudha Pandit, MD, Academic Fellow, Department of Gastroenterology and Hepatology, Louisiana State University, Health Science Center, 1501 Kings HWY, Shreveport, LA 71103, United States. spandi@lsuhsc.edu
Telephone: +1-318-675-5982 Fax: +1-318-675-5957
Received: February 18, 2019
Peer-review started: February 18, 2019
First decision: February 26, 2019
Revised: March 11, 2019
Accepted: April 8, 2019
Article in press: April 9, 2019
Published online: April 16, 2019
Abstract
BACKGROUND

Self-expanding metal stents are the main palliative treatment modality for unresectable esophageal cancer. Gastroesophageal reflux is a common adverse outcome after placement of esophageal stent for cancer involving the gastroesophageal junction and the gastric cardia. Anti-reflux stents with valve have been designed to prevent the acid reflux. The superiority of anti-reflux stent over standard stent in preventing gastroesophageal reflux has not been established well. This study compares the anti-reflux stent and the standard stent in terms of their efficacy to prevent acid reflux.

AIM

To compare the standard and the anti-reflux stents in terms of their efficacy, safety, and complications.

METHODS

The meta-analysis included 8 randomized clinical trials (RCTs) to compare pooled outcomes of total 395 patients. Primary outcomes include improvement in reflux symptoms and dysphagia score. Secondary outcomes include complications of stent migration, occlusion, and bleeding.

RESULTS

A total of eight RCTs were included in the meta-analysis. Compared to the standard stent, the anti-reflux stent showed a trend towards reduction in the dysphagia score without reaching a statistical significance [Standardized mean difference (SMD): -0.33 (-0.71, 0.05); P = 0.09, I2: 37%]. There was no statistical difference in the gastrointestinal reflux (GER) scores between the two types of stents [SMD: -0.17 (-0.78, 0.45); P = 0.008, I2: 74%]. Compared to standard stent, anti-reflux stent showed no difference in the risk of stent migration [OR: 1.37 (0.66, 2.83); P = 0.40, I2: 0 %], bleeding [OR: 1.43 (0.40, 5.13); P = 0.59, I2: 0 %], and obstruction [OR: 1.66 (0.60, 4.60); P = 0.33, I2: 0 %].

CONCLUSION

Traditional self-expanding standard esophageal stent and anti-reflux stent with valve are similar in terms of outcomes and complications.

Keywords: Self expanding metal stent, Anti-reflux stent, Randomized controlled trial, Esophageal stent, Meta-analysis

Core tip: In this meta-analysis, we studied and compared the traditional standard self-expanding metal stent and anti-reflux stent in terms of their efficacy and safety. We included 8 randomized controlled trials in our meta-analysis from 3 different databases. We expected anti-reflux stent with valves, as its name suggests, to show improvement in reflux symptom score, however, this was not observed in our study. This review study shows that there is no difference between standard stent and anti-reflux stent in terms of improving reflux symptom and dysphagia score. This study also confirms that there is no difference in terms of complications including stent migration, bleeding, and obstruction between standard stent and anti-reflux stent.