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Self-expanding metal stents for acute refractory esophageal variceal bleeding: A systematic review and meta-analysis.

ABSTRACT: Esophageal variceal bleeding is a severe complication of portal hypertension with significant morbidity and mortality. A substantial portion of cirrhotics fail to respond to conventional medical therapy and band ligation, necessitating alternative treatments including self-expanding metal stent (SEMS) placement for acute refractory esophageal variceal bleeding. In the present study, we carried out a systematic review and structured meta-analysis of all eligible studies to evaluate the technical feasibility, safety, clinical efficacy, and survival advantage of SEMS placement for the treatment of of acute esophageal variceal bleeding.Searches of PubMed, EMBASE, Web of Science, and the Cochrane Library databases were carried out through December 2015. Individual study proportions were transformed into a quantity using the Freeman-Tukey variant of the arcsine square root transformed proportion. Combined weighted proportions, and meta-regression were then determined.The search yielded 12 studies involving n = 155 patients included in our meta-analysis. Pooled clinical success rate in achieving hemostasis within 24 h was 96% (95% CI, 0.90-1.00). Technical success for SEMS deployment endoscopically was achieved in 97% of patients (95% CI, 0.91-1.00). Total adverse events (including rebleeding after 48 h, ulceration, and stent migration) were shown in 36% of patients after SEMS placement (95% CI, 0.23-0.50). Pooled 30-day and 60-day survival rates were 68% (95% CI, 0.56-0.80) and 64% (95% CI, 0.48-0.78), respectively.This study demonstrated that esophageal SEMS placement is a technically feasible modality and highly efficacious in achieving hemostasis in acute esophageal variceal hemorrhage.

SUBMITTER: McCarty TR

PROVIDER: S-EPMC4940258 | biostudies-literature | 2016 Jul

REPOSITORIES: biostudies-literature

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Self-expanding metal stents for acute refractory esophageal variceal bleeding: A systematic review and meta-analysis.

McCarty Thomas R TR Njei Basile B

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 20160422 5

<h4>Background and aim</h4>Esophageal variceal bleeding is a severe complication of portal hypertension with significant morbidity and mortality. A substantial portion of cirrhotics fail to respond to conventional medical therapy and band ligation, necessitating alternative treatments including self-expanding metal stent (SEMS) placement for acute refractory esophageal variceal bleeding. In the present study, we carried out a systematic review and structured meta-analysis of all eligible studies ...[more]

PMID: 26845490

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Project description:BACKGROUND:To explore the long-term oncological safety of using self-expanding metal stents (SEMS) as a bridge to surgery for acute obstructive colorectal cancer by comparing the pathological results of emergency surgery (ES) with elective surgery after the placement of SEMS. METHODS:Studies comparing SEMS as a bridge to surgery with emergency surgery for acute obstructive colorectal cancer were retrieved through the databases of Pubmed, Embase, and Cochrane libraries, and a meta-analysis was conducted based on the pathological results of the two treatments. Risk ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated for the outcomes under random effects model. RESULTS:A total of 27 studies were included, including 3 randomized controlled studies, 2 prospective studies, and 22 retrospective studies, with a total of 3737 patients. The presence of perineural invasion (RR?=?0.58, 95% CI 0.48, 0.71, P?<?0.00001), lymphovascular invasion (RR?=?0.68, 95% CI 0.47, 0.99, P?=?0.004) and vascular invasion (RR?=?0.66, 95% CI 0.45, 0.99, P?=?0.04) in SEMS group were significantly higher than those in ES group, and there was no significant difference in lymphatic invasion (RR?=?0.92, 95% CI 0.77, 1.09, P?=?0.33). The number of lymph nodes harvested in SEMS group was significantly higher than that in ES group (MD?=?-?3.18, 95% CI -?4.47, -?1.90, P?<?0.00001). While no significant difference was found in the number of positive lymph nodes (MD?=?-?0.11, 95% CI -?0.63, 0.42, P?=?0.69) and N stage [N0 (RR?=?1.03, 95% CI 0.92, 1.15, P?=?0.60), N1 (RR?=?0.99, 95% CI 0.87, 1.14, P?=?0.91), N2 (RR?=?0.94, 95% CI 0.77, 1.15, P?=?0.53)]. CONCLUSIONS:SEMS implantation in patients with acute malignant obstructive colorectal cancer may lead to an increase in adverse tumor pathological characteristics, and these characteristics are mostly related to the poor prognosis of colorectal cancer. Although the adverse effect of SEMS on long-term survival has not been demonstrated, their adverse effects cannot be ignored. The use of SEMS as the preferred treatment for patients with resectable obstructive colorectal cancer remains to be carefully weighed, especially when patients are young or the surgical risk is not very high.

Dataset Information

Self-expanding metal stents for acute refractory esophageal variceal bleeding: A systematic review and meta-analysis.

Publications

Self-expanding metal stents for acute refractory esophageal variceal bleeding: A systematic review and meta-analysis.

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