Esophageal stents for benign refractory strictures: a meta-analysis

Background and aims: Fully covered self-expanding removable stents (SERS) have been considered a viable alternative to serial bougienage. The primary aim of this meta-analysis was to determine the efficacy of SERS for refractory esophageal strictures. Methods: Medline, Embase, and PubMed databases were searched using the keywords "esophageal stricture," "esophageal stents," "benign stricture," "dysphagia," "caustic," "peptic stricture," "anastomotic," "radiation," and "dysphagia" for the period from January 1965 to June 2010. Articles were selected for review independently by two authors (T. T. and J. M.) on the basis of pre-defined inclusion criteria, and the data collected. A meta-analysis using a random effects model was done. Results: Eight studies with a total of 199 patients were included in the final analysis (104-males, average age 56 years, range: 49-68 years). Over-all, 46.2% of patients (95 % CI: 38.3%-54.1 %) had dysphagia improvement at an average follow up of 74 weeks. There was a significant difference (P = 0.019) in dysphagia improvement for patients with Polyflex stents (55.3 %; 95% CI: 44.4%-65.9 %) versus nitinol stents (21.8 %; 95% CI: 13.7%-33.7 %). On meta-regression, patient sex (P = 0.80), patient age (P = 0.725), corrosive etiology (P = 0.30), stricture location (P = 0.273), stricture length (P = 0.32), time of removal (P = 0.056), and duration of follow-up (0.35) had no significance influence on the outcome. The migration rate was 26.4% (95 % CI: 25.3%-39.3 %). Conclusions: Although the efficacy of SERS placement in benign refractory strictures is 46.2 %, it is associated with migration rate of 26.4 %. Nevertheless, the use of these temporary stents, which can be successfully removed in 87% of patients, is an alluring prospect for treating patients with this difficult condition.