Comparison of fully-covered vs partially covered self-expanding metallic stents for palliative treatment of inoperable esophageal malignancy: a systematic review and meta-analysis

Abstract

Background: This study aimed to compare clinical outcomes following placement of fully covered self-expanding metallic stents (FCSEMS) vs partially covered self-expanding metallic stents (PCSEMS) for palliative treatment of inoperable esophageal cancer. Methods: We searched PubMed, ScienceDirect, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases from inception up to 10th July 2019. Studies comparing clinical outcomes with FCSEMS vs PCSEMS in patients with inoperable esophageal cancer requiring palliative treatment for dysphagia were included. Results: Five studies were included in the review. Two hundred twenty-nine patients received FCSEMS while 313 patients received PCSEMS in the five studies. There was no difference in the rates of stent migration between FCSEMS and PCSEMS (Odds ratio [OR] 0.63, 95%CI 0.37-1.08, P = 0.09; I 2 = 0%). Meta-analysis indicated no significant difference in technical success between the two groups (OR 1.32, 95%CI 0.30-5.03, P = 0.78; I 2 = 12%). Improvement in dysphagia was reported with both FCSEMS and PCSEMS in the included studies. There was no difference between the two stents for obstruction due to tissue growth (OR 0.81, 95%CI 0.47-1.39, P = 0.44; I 2 = 2%) or by food (OR 0.41, 95%CI 0.10-1.62, P = 0.20; I 2 = 29%). Incidence of bleeding (OR 0.57, 95%CI 0.21-1.58, P = 0.28; I 2 = 0%) and chest pain (OR 1.06, 95%CI 0.44-2.57, P = 0.89; I 2 = 0%) was similar in the two groups. Sensitivity analysis and subgroup analysis of RCTs and non-RCTs produced similar results. The overall quality of studies was not high. Conclusion: Our results indicate that there is no difference in stent migration, and stent obstruction, with FCSEMS or PCSEMS when used for palliative treatment of esophageal malignancy.

Adverse events associated with EGD and EGD-related techniques

“…After the title and abstract screen, we made the decision on whether to cite studies included in the second round in the final review document based on the above criteria. Data on AEs were then extracted from the full-text studies selected for inclusion and presented according to each EGD-related cancer), 77,78 28.6% (migration, benign), 80 2.4%-12.4% (occlusion) 77,78 Gastroduodenal: 4.3% (migration), 83 12.6% (occlusion) 82,83 Stent migration: covered stents, 79 stent for benign disease 80 Stent occlusion: uncovered stents 82 Hemostasis or prophylaxis of bleeding 1.4% (with gluing) 100 Not reported Aspiration pneumonia (with balloon tamponade):…”

“…78 In a 2020 meta-analysis of 231 patients that compared fully covered to partially covered SEMS insertion for palliation in esophageal cancer, the bleeding risk was the same for both stent types. 79 In a meta-analysis including 444 patients with stents placed for benign indications, the risk of bleeding was 1.8%. 80 Gastroduodenal stent placement.…”

Palliation of Malignant Dysphagia: Dilation, Stents, Cryoablation or PDT: The GI Perspective

“…Importantly, a recent meta-analysis found no difference in stent migration or stent obstruction between FC-SEMs or PC-SEMS for the palliation of esophageal cancer. 13…”

A Computational Framework Examining the Mechanical Behaviour of Bare and Polymer-Covered Self-Expanding Laser-Cut Stents

“…Covering a laser-cut stent replaces the open spaces between the stent struts with a polymer membrane to create a solid-walled tubular device and these have been effective in excluding aneurysms [9], preventing tumour in-growth [10], and sealing perforated vessels [11]. Covered stents also have benefits in reducing the incidence of tissue in-growth and re-embolization, as the cover acts as a mechanical barrier between the bloodstream and the vessel wall [12,13].…”