Division of Gastroenterology & Hepatology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, USA.
Division of Gastroenterology, The Queens Medical Center, Honolulu, HI, USA.
Surg Endosc. 2018 Feb;32(2):675-681. doi: 10.1007/s00464-017-5720-9. Epub 2017 Jul 19.
Covered self-expandable metal stents (SEMS) are utilized for the management of benign and malignant esophageal conditions; however, covered SEMS are prone to migration. Endoscopic suture fixation may mitigate the migration risk of covered esophageal SEMS. Hence, we conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of endoscopic suture fixation for covered esophageal SEMS.
Following PRISMA guidelines, we performed a systematic review from 2011 to 2016 to identify studies (case control/case series) reporting the technical success and migration rate of covered esophageal SEMS following endoscopic suture fixation. We searched multiple electronic databases and conference proceedings. We calculated pooled rates (and 95% confidence intervals [CI]) of technical success and stent migration using a random effects model.
We identified 14 studies (212 patients) describing covered esophageal SEMS placement with endoscopic suture fixation. When reported, SEMS indications included leak/fistula (n = 75), stricture (n = 65), perforation (n = 10), and achalasia (n = 4). The pooled technical success rate was 96.7% (95% CI 92.3-98.6), without heterogeneity (I = 0%). We identified 29 SEMS migrations at rate of 15.9% (95% CI 11.4-21.6), without heterogeneity (I = 0%). Publication bias was observed, and using the trim-and-fill method, a more conservative estimate for stent migration was 17.0%. Suture-related adverse events were estimated to occur in 3.7% (95% CI 1.6-8.2) of cases.
Endoscopic suture fixation of covered esophageal SEMS appears to reduce stent migration when compared to published rates of non-anchored SEMS. However, SEMS migration still occurs in approximately 1 out of 6 cases despite excellent immediate technical success and low risk of suture-related adverse events.
覆膜自膨式金属支架（SEMS）用于治疗良性和恶性食管疾病；然而，覆膜 SEMS 容易迁移。内镜缝合固定可降低覆膜食管 SEMS 迁移的风险。因此，我们进行了系统评价和荟萃分析，以评估内镜缝合固定治疗覆膜食管 SEMS 的有效性和安全性。
根据 PRISMA 指南，我们进行了系统评价，从 2011 年到 2016 年，以确定报道内镜缝合固定治疗后覆膜食管 SEMS 技术成功率和迁移率的研究（病例对照/病例系列）。我们搜索了多个电子数据库和会议记录。我们使用随机效应模型计算技术成功率和支架迁移的汇总率（和 95%置信区间 [CI]）。
我们确定了 14 项研究（212 例患者），描述了内镜缝合固定治疗覆膜食管 SEMS。当报道时，SEMS 适应证包括漏/瘘（n=75）、狭窄（n=65）、穿孔（n=10）和贲门失弛缓症（n=4）。汇总技术成功率为 96.7%（95%CI 92.3-98.6），无异质性（I²=0%）。我们发现 29 个 SEMS 迁移，迁移率为 15.9%（95%CI 11.4-21.6），无异质性（I²=0%）。存在发表偏倚，使用修剪和填充方法，支架迁移的更保守估计值为 17.0%。估计缝合相关不良事件发生在 3.7%（95%CI 1.6-8.2）的病例中。
与非锚定 SEMS 的已发表率相比，内镜缝合固定覆膜食管 SEMS 似乎可降低支架迁移的风险。然而，尽管技术成功率非常高，且缝合相关不良事件的风险低，但 SEMS 迁移仍在大约每 6 例中发生 1 例。
