Hussain Zeiad, Diamantopoulos Athanasios, Krokidis Miltiadis, Katsanos Konstantinos
Zeiad Hussain, Athanasios Diamantopoulos, Konstantinos Katsanos, Department of Interventional Radiology, Guy's and St.Thomas' Hospitals, NHS Foundation Trust, London SE1 7EH, United Kingdom.
World J Gastroenterol. 2016 Sep 14;22(34):7841-50. doi: 10.3748/wjg.v22.i34.7841.
To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal obstructions.
A systematic review and meta-analysis was performed following the PRISMA process. PubMed (Medline), EMBASE (Excerpta Medical Database), AMED (Allied and Complementary medicine Database), Scopus and online content, were searched for studies reporting on the NiTi-S polyurethane-covered double oesophageal stent for the treatment of malignant dysphagia. Weighted pooled outcomes were synthesized with a random effects model to account for clinical heterogeneity. All studies reporting the outcome of palliative management of dysphagia due to histologically confirmed malignant oesophageal obstruction using double-layered covered nitinol stent were included. The level of statistical significance was set at α = 0.05.
Six clinical studies comprising 250 patients in total were identified. Pooled technical success of stent insertion was 97.2% (95%CI: 94.8%-98.9%; I (2) = 5.8%). Pooled complication rate was 27.6% (95%CI: 20.7%-35.2%; I (2) = 41.9%). Weighted improvement of dysphagia on a scale of 0-5 scoring system was -2.00 [95%CI: -2.29%-(-1.72%); I (2) = 87%]. Distal stent migration was documented in 10 out of the 250 cases examined. Pooled stent migration rate was 4.7% (95%CI: 2.5%-7.7%; I (2) = 0%). Finally, tumour overgrowth was reported in 34 out of the 250 cases with pooled rate of tumour overgrowth of 11.2% (95%CI: 3.7%-22.1%; I (2) = 82.2%). No funnel plot asymmetry to suggest publication bias (bias = 0.39, P = 0.78). In the sensitivity analysis all results were largely similar between the fixed and random effects models.
The double-layered nitinol stent provides immediate relief of malignant dysphagia with low rates of stent migration and tumour overgrowth.
探讨双层覆膜支架治疗恶性食管梗阻的疗效。
按照PRISMA流程进行系统评价和荟萃分析。检索了PubMed（医学索引数据库）、EMBASE（医学文摘数据库）、AMED（联合与补充医学数据库）、Scopus及在线文献，查找关于镍钛-聚氨基甲酸乙酯覆膜双食管支架治疗恶性吞咽困难的研究。采用随机效应模型综合加权合并结果，以考虑临床异质性。纳入所有使用双层覆膜镍钛合金支架治疗经组织学证实的恶性食管梗阻所致吞咽困难姑息治疗结局的研究。设定统计学显著性水平为α = 0.05。
共纳入6项临床研究，总计250例患者。支架置入的合并技术成功率为97.2%（95%置信区间：94.8%-98.9%；I² = 5.8%）。合并并发症发生率为27.6%（95%置信区间：20.7%-35.2%；I² = 41.9%）。在0-5评分系统中，吞咽困难的加权改善值为-2.00 [95%置信区间：-2.29%-（-1.72%）；I² = 87%]。在250例检查病例中，有10例记录了远端支架移位。合并支架移位率为4.7%（95%置信区间：2.5%-7.7%；I² = 0%）。最后，250例中有34例报告了肿瘤过度生长，肿瘤过度生长的合并发生率为11.2%（95%置信区间：3.7%-22.1%；I² = 82.2%）。漏斗图无不对称性提示发表偏倚（偏倚 = 0.39，P = 0.78）。在敏感性分析中，固定效应模型和随机效应模型的所有结果基本相似。
双层镍钛合金支架可立即缓解恶性吞咽困难，且支架移位和肿瘤过度生长发生率低。
