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Double-layered covered stent for the treatment of malignant oesophageal obstructions: Systematic review and meta-analysis

View Article: PubMed Central - PubMed

ABSTRACT

Aim: To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal obstructions.

Methods: 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.

Results: 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%; I2 = 5.8%). Pooled complication rate was 27.6% (95%CI: 20.7%-35.2%; I2 = 41.9%). Weighted improvement of dysphagia on a scale of 0-5 scoring system was -2.00 [95%CI: -2.29%-(-1.72%); I2 = 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%; I2 = 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%; I2 = 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.

Conclusion: The double-layered nitinol stent provides immediate relief of malignant dysphagia with low rates of stent migration and tumour overgrowth

No MeSH data available.


Related in: MedlinePlus

Tumour overgrowth. A: Random effects forest plot of weighted pooled estimate; B: Respective funnel plot for bias assessment (the standard error of the proportion was plotted against the proportion for each study).
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Figure 6: Tumour overgrowth. A: Random effects forest plot of weighted pooled estimate; B: Respective funnel plot for bias assessment (the standard error of the proportion was plotted against the proportion for each study).

Mentions: Finally, tumour overgrowth was reported in 34 out of the 250 cases in total. Pooled overgrowth rate was 11.2% (95%CI: 3.7%-22.1%; Figure 6). There was high statistical heterogeneity (I2 = 82.2%, P < 0.0001) and some funnel plot asymmetry suggestive of potential publication bias (bias = 4.13, P = 0.06).


Double-layered covered stent for the treatment of malignant oesophageal obstructions: Systematic review and meta-analysis
Tumour overgrowth. A: Random effects forest plot of weighted pooled estimate; B: Respective funnel plot for bias assessment (the standard error of the proportion was plotted against the proportion for each study).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016384&req=5

Figure 6: Tumour overgrowth. A: Random effects forest plot of weighted pooled estimate; B: Respective funnel plot for bias assessment (the standard error of the proportion was plotted against the proportion for each study).
Mentions: Finally, tumour overgrowth was reported in 34 out of the 250 cases in total. Pooled overgrowth rate was 11.2% (95%CI: 3.7%-22.1%; Figure 6). There was high statistical heterogeneity (I2 = 82.2%, P < 0.0001) and some funnel plot asymmetry suggestive of potential publication bias (bias = 4.13, P = 0.06).

View Article: PubMed Central - PubMed

ABSTRACT

Aim: To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal obstructions.

Methods: 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 &alpha; = 0.05.

Results: 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%; I2 = 5.8%). Pooled complication rate was 27.6% (95%CI: 20.7%-35.2%; I2 = 41.9%). Weighted improvement of dysphagia on a scale of 0-5 scoring system was -2.00 [95%CI: -2.29%-(-1.72%); I2 = 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%; I2 = 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%; I2 = 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.

Conclusion: The double-layered nitinol stent provides immediate relief of malignant dysphagia with low rates of stent migration and tumour overgrowth

No MeSH data available.


Related in: MedlinePlus