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

Table 1 Studies included in meta-analysis

	Ref.	Study design	SEMS		Total
			Palliation	BTS
Palliation
1	Ptok[23]-2006-Germany	Prospective, Single Center	48	0	48
2	Repici[22]-2007-Europe	Prospective, Multicenter	44	0	44
3	Im[33]-2008-South Korea	Prospective, Single Center	49	0	49
4	Suh[34]-2010-South Korea	Retrospective, Single Center	55	0	55
5	Jung[35]-2010-South Korea	Retrospective, Single Center	39	0	39
BTS
6	Fregonese[24]-2008-United Kingdom	Prospective and Retrospective, Multicenter	0	36	36
7	Li[36]-2010-China	Prospective, Single Center	0	52	52
Palliation and BTS
8	Meisner[25]-2004-Denmark	Retrospective, Single Center	51	38	89
9	Soto[26]-2006-Spain	Retrospective, Single Center	36	22	58
10	Lee[37]-2007-South Korea	Prospective, Single Center	37	43	80
11	Repici[27]-2008-Europe	Prospective, Multicenter	23	19	42
12	Stipa[28]-2008- Italy	Retrospective, Single Center	9	22	31
13	Branger[29]-2010-France	Retrospective, Single Center	66	27	93
14	Fernandez-Esparrach[10]-2010-Spain	Retrospective, Single Center	38	9	47
15	Lee[44]-2010-United States	Retrospective, Single Center	41	5	46
16	Park[38]-2010-South Korea	Prospective, Single Center	107	44	151
17	Small[11]-2010-United States	Retrospective, Single Center	168	65	233
18	West[30]-2010-United Kingdom	Retrospective, Multicenter	21	6	27
19	Meisner[31]-2011-Denmark	Prospective, Multicenter	257	182	439
Palliative SEMS vs palliative surgery
20	Law[7]-2003-China	Retrospective, Single Center	30	0	61
21	Carne[8]-2004-New Zealand	Retrospective, Single Center	25	0	44
22	Suarez[32]-2009-Spain	Retrospective, Single Center	45	0	98
23	Vemulapalli[45]-2009-United States	Retrospective, Single Center	53	0	123
24	Lee[39]-2011-South Korea	Retrospective, Single Center	71	0	144
SEMS as BTS vs emergency surgery
25	Ng[40]-2006-Hong Kong	Retrospective, Single Center	0	20	60
26	Cheung[41]-2009-China	Randomized Controlled Trial, Single Center	0	24	48
27	Guo[42]-2011-China	Retrospective, Single Center	0	34	92
28	vanHooft[5]-2011-The Netherlands	Randomized Controlled Trial, Multicenter	0	47	98
29	Ho[43]-2011-Singapore	Randomized Controlled Trial, Single Center	0	20	39
30	Abdel-Hamid[46]-2013-Egypt	Randomized Controlled Trial, Single Center	0	30	60
	Total		1313	745	2058

BTS: Bridge to surgery; SEMS: Self-expandable metal stent.

Table 2 Efficacy of self-expandable metal stent placement

Category and subgroups		Studies	Event rate (%)	95%CI	P value	I2 value
Technical success		30	94.0	91.8-95.6	0.000	58.07
Indication	Palliation	10	94.2	91.3-96.1	0.580	0.00
	BTS	8	89.4	79.5-94.8	0.003	67.14
Center	Single Center	24	94.1	92.1-95.6	0.06	32.74
	Multicenter	6	93.3	83.1-97.5	0.000	84.70
Design	Prospective	11	93.1	86.9-96.5	0.000	80.94
	Retrospective	18	94.4	92.7-95.7	0.846	0.00
Region	Asia	12	95.2	91.0-97.5	0.005	58.82
	Europe	13	92.8	89-95.4	0.001	65.40
	North America	3	96.0	93.2-97.6	0.679	0.00
Clinical success		29	90.6	88.1-92.7	0.001	50.58
Indication	Palliation	10	91.7	88.7-94	0.719	0.00
	BTS	8	87.9	78.1-93.7	0.004	66.35
Center	Single Center	23	90.8	88.4-92.7	0.042	36.52
	Multicenter	5	89.7	76.7-95.9	0.004	73.93
Design	Prospective	10	89.7	82.6-94.0	0.001	72.48
	Retrospective	18	91.0	88.7-92.3	0.238	18.04
Region	Asia	12	91.2	87.2-94.1	0.044	45.37
	Europe	12	89.1	84.5-92.3	0.029	48.73
	North America	3	92.5	83.9-96.7	0.040	69.03

BTS: Bridge to surgery.

Table 3 Safety of self-expandable metal stent placement

Category and subgroups		Studies	Event rate (%)	95%CI	P value	I2 value
Overall complication rate		25	23.1	18.5-28.6	0.000	81.86
Indication	Palliation	10	27.3	18.7-38	0.000	80.60
	BTS	3	13.8	8.3-22.2	0.371	0.00
Center	Single Center	20	25.2	20.1-31.1	0.000	78.20
	Multicenter	5	16.2	10.8-23.6	0.058	56.11
Design	Prospective	8	20.6	13.6-30.0	0.000	82.64
	Retrospective	16	25.0	19.1-31.8	0.000	79.08
Center	Asia	9	25.1	16.1-36.9	0.000	84.93
	Europe	12	21.3	15.1-29.1	0.000	81.28
	North America	3	28.0	21.9-35	1.000	0.00
Obstruction rate		25	8.3	6.0-11.4	0.000	68.79
Indication	Palliation	10	9.5	5.4-16.4	0.001	69.55
	BTS	3	1.9	0.5-7.1	0.959	0.00
Center	Single Center	20	8.7	6.2-12.1	0.000	63.23
	Multicenter	5	3.1	1.8-5.4	0.000	80.21
Design	Prospective	8	8.2	4.9-13.5	0.001	70.11
	Retrospective	16	8.7	5.7-13.0	0.000	67.79
Region	Asia	9	9.8	5.3-17.2	0.000	74.58
	Europe	12	7.7	4.8-12.1	0.001	63.77
	North America	3	7.5	5.1-10.9	0.961	0.00
Migration rate		29	7.6	5.7-10.0	0.000	55.48
Indication	Palliation	10	10.2	7.1-14.5	0.150	32.56
	BTS	7	4.1	2.0-8.1	0.687	0.00
Center	Single Center	23	9.7	7.7-12.1	0.061	33.51
	Multicenter	6	2.1	1.2-3.6	0.977	0.00
Design	Prospective	10	5.5	2.6-11.3	0.000	79.25
	Retrospective	18	9.0	7.3-11.1	0.389	5.55
Center	Asia	12	10.2	7.9-13.0	0.434	0.95
	Europe	13	5.4	2.9-10.0	0.000	75.80
	North America	3	7.8	5.4-11.3	0.972	0.00
Perforation rate		29	4.9	3.6-6.6	0.037	34.39
Indication	Palliation	10	5.4	2.9-9.8	0.054	46.00
	BTS	7	4.0	1.9-8.2	0.646	0.00
Center	Single Center	23	5.1	3.6-7.2	0.042	36.56
	Multicenter	6	4.0	2.6-4.7	0.586	0.00
Design	Prospective	10	3.1	2.1-4.7	0.722	0.00
	Retrospective	18	6.2	4.4-8.6	0.117	29.48
Center	Asia	12	3.6	1.8-7.0	0.024	50.02
	Europe	13	4.4	3.2-6.0	0.472	0.00
	North America	3	8.4	5.8-11.9	0.463	0.00

BTS: Bridge to surgery.

Table 4 Re-intervention rates

Category and subgroups		Studies	Event rate (%)	95%CI	P value	I2 value
Overall re-intervention rate		20	13.6	10.1-18.0	0.000	68.79
Indication	Palliation	8	16.7	11.8-22.9	0.077	45.30
	BTS	4	3.3	1.2-8.4	0.758	0.00
Center	Single Center	17	14.2	10.3-19.2	0.000	70.10
	Multicenter	3	10.3	4.3-22.6	0.114	53.94
Design	Prospective	7	14.8	9.5-22.4	0.069	48.81
	Retrospective	12	13.6	9.1-19.9	0.000	75.17
Region	Asia	6	11.6	6.8-19.3	0.066	51.74
	Europe	9	13.2	8.8-19.4	0.011	59.63
	North America	3	14.7	11.3-19.0	0.034	70.54
Surgical intervention rate		20	5.8	3.9-8.5	0.011	46.79
Indication	Palliation	8	7.6	4.1-13.8	0.048	50.62
	BTS	4	3.2	1.1-8.7	0.641	0.00
Center	Single Center	17	6.1	4.0-9.2	0.009	50.50
	Multicenter	3	3.6	1.3-9.2	0.675	0.00
Design	Prospective	7	5.1	2.6-9.8	0.193	30.76
	Retrospective	12	5.9	3.5-9.9	0.007	57.59
Region	Asia	6	4.2	2.2-7.9	0.411	0.81
	Europe	9	5.4	2.9-9.9	0.051	48.24
	North America	3	9.2	3.7-21.2	0.016	75.87
Endoscopic re-stent rate		20	8.0	6.4-9.9	0.439	2.15
Indication	Palliation	8	9.7	6.6-14.2	0.304	16.02
	BTS	4	1.5	0.4-5.7	0.973	0.00
Center	Single Center	17	8.3	6.6-10.2	0.486	0.00
	Multicenter	3	3.9	1.1-12.3	0.296	17.95
Design	Prospective	7	8.4	5.3-13.1	0.320	14.45
	Retrospective	12	7.9	6.1-10.1	0.486	0.00
Region	Asia	6	8.5	4.5-15.3	0.113	43.89
	Europe	9	6.8	4.8-9.7	0.706	0.00
	North America	3	8.3	5.7-11.8	0.600	0.00
Other endoscopic intervention rate		21	3.8	2.7-5.3	0.620	0.00
Indication	Palliation	8	3.1	1.5-6.1	0.601	0.00
	BTS	4	1.8	0.5-6.0	0.993	0.00
Center	Single Center	18	3.4	2.3-4.8	0.737	0.00
	Multicenter	3	6.3	2.7-13.7	0.333	8.99
Design	Prospective	7	4.2	2.3-7.7	0.412	1.59
	Retrospective	13	3.7	2.5-5.5	0.553	0.00
Region	Asia	6	1.8	0.8-4.3	0.980	0.00
	Europe	10	3.7	2.0-6.6	0.280	17.68
	North America	3	4.7	2.9-7.8	0.475	0.00

BTS: Bridge to surgery.