International Journal of Medical Sciences

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13 December 2017

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Int J Med Sci 2013; 10(7):825-835. doi:10.7150/ijms.5969

Research Paper

A Systematic Review and Meta-Analysis of Randomized Trials and Prospective Studies Comparing Covered and Bare Self-Expandable Metal Stents for the Treatment of Malignant Obstruction in the Digestive Tract

Zhiping Yang1,*, Qiong Wu1,*, Fang Wang2,*, Xiaofei Ye3,*, Xingshun Qi1, Daiming Fan1 ✉

1. Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China;
2. Department of Gastroenterology, Affiliated Hospital of Ningxia Medical University, Yinchuan, China;
3. Department of Health Statistics, Second Military Medical University, Shanghai, China.
* These authors contributed equally to this work.

Abstract

Background: Self-expandable metal stents (SEMS) are widely used for the palliative treatment of malignant gastrointestinal obstruction. Our aim was to evaluate the evidence comparing covered and bare SEMS in the digestive tract using meta-analytical techniques.

Methods: A literature search was performed using PubMed, Cochrane Library, and Embase databases for comparative studies assessing the two types of stents. The primary outcomes of interest were stent patency and patient survival; second outcomes included technical success, clinical success, tumor ingrowth, tumor overgrowth, and stent migration. A random-effects model was conducted. Pooled analysis was done separately based on the different segments of the digestive tract.

Results: Eleven studies (8 randomized controlled trials and 3 prospective cohort studies) including a total of 1376 patients were identified. Covered SEMS were equivalent to bare SEMS in terms of technical success, clinical success, stent patency (gastroduodenal obstruction: HR =0.87, 95% CI 0.53-1.42; colorectal obstruction: HR =0.89, 95% CI 0.18-4.45; biliary obstruction: HR =0.73, 95% CI 0.41-1.32) and survival rates (esophageal obstruction: HR =1.80, 95% CI 0.73-4.44; gastroduodenal obstruction: HR =0.83, 95% CI 0.55-1.26; biliary obstruction: HR =0.99, 95% CI 0.77-1.28), although bare stents were more prone to tumor ingrowth (esophageal obstruction: RR =0.10, 95% CI 0.01-0.77; gastroduodenal obstruction: RR =0.12, 95% CI 0.03-0.55; colorectal obstruction: RR =0.21, 95% CI 0.06-0.70; biliary obstruction: RR =0.21, 95% CI 0.06-0.69), whereas covered stents had the higher risk of stent migration (gastroduodenal obstruction: RR =5.01, 95% CI 1.53-16.43; colorectal obstruction: RR =11.70, 95% CI 2.84-48.27; biliary obstruction: RR =8.11, 95% CI 1.47-44.76) and tumor overgrowth (biliary obstruction: RR =2.03, 95% CI 1.08-3.78).

Conclusion: Both covered and bare SEMS are comparable in efficacy for the palliative treatment of malignant obstruction in the digestive tract. Each type of the stents has its own merit and demerit relatively.

Keywords: covered stent, digestive tract, gastrointestinal cancer, malignant obstruction, self-expandable metal stent.

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) License. See http://ivyspring.com/terms for full terms and conditions.
How to cite this article:
Yang Z, Wu Q, Wang F, Ye X, Qi X, Fan D. A Systematic Review and Meta-Analysis of Randomized Trials and Prospective Studies Comparing Covered and Bare Self-Expandable Metal Stents for the Treatment of Malignant Obstruction in the Digestive Tract. Int J Med Sci 2013; 10(7):825-835. doi:10.7150/ijms.5969. Available from http://www.medsci.org/v10p0825.htm