Covered versus uncovered self-expandable metallic stents for palliation of malignant gastric outlet obstruction: a systematic review and meta-analysis

Abstract

BackgroundSelf-expandable metallic stents (SEMSs) are widely used for palliation of malignant gastric outlet obstruction (GOO). There are two types of SEMS, covered and uncovered, each with its own advantages and disadvantages. We aimed to compare the efficacy and safety between uncovered and covered SEMSs in the palliation of malignant gastric outlet obstruction.MethodsDatabases including PubMed, EMBASE, the Cochrane Library, the Science Citation Index and momentous meeting abstracts were searched and evaluated by two reviewers independently.ResultsNine trials involving 849 patients were analyzed. Meta-analysis showed there was no significant difference in technical success rate (RR 1.0, 95% CI [0.98, 1.01]), clinical success rate (RR 1.04, 95% CI [0.98, 1.11]), post-stenting dysphagia score (WMD −0.01, 95% CI [−0.52, 0.50]), stent patency (WMD −0.31, 95% CI [−1.73, 1.11]), overall complications (RR 1.07, 95% CI [0.87, 1.32]) and reintervention rate (RR 1.30, 95% CI [0.92, 1.83]) between covered and uncovered SEMSs group. However, covered SEMSs were associated with higher migration rate (RR 3.48, 95% CI [2.16, 5.62], P < 0.00001) and lower obstruction rate (RR 0.42, 95% CI [0.24, 0.73], P = 0.002).ConclusionsIn the palliative treatment of malignant gastric outlet obstruction, both covered and uncovered SEMSs are safely and effective. Covered stents can reduce the risk of restenosis, whereas uncovered stents are effective in decreasing stent migration.

Covered duodenal self‐expandable metal stents prolong biliary stent patency in double stenting: The largest series of bilioduodenal obstruction

“…Tumor ingrowth in U‐SEMS occurs in 4% to 26% of patients with duodenal U‐SEMS, similar to our findings (U‐SEMS vs C‐SEMS: 7.7% [5/65] vs 0.0% [0/44]; P = 0.08). In duodenal C‐SEMS, stent migration is a major adverse event that requires re‐intervention and occurs at a frequency of 16% to 25% . In the present study, the incidence of migration did not differ significantly between U‐SEMS and C‐SEMS (3.1% [2/65] vs 6.8% [3/44], P = 0.365) and was lower than in the previous reports.…”

Survival and clinical outcome after endoscopic duodenal stent placement for malignant gastric outlet obstruction: comparison of pancreatic cancer and nonpancreatic cancer

“…These results are consistent with a recent meta-analysis of 9 trials (including 3 randomized, controlled studies) examining the efficacy of duodenal stent for malignant GOO. 31 Stent placement is not only beneficial as a palliative intervention alleviating symptoms and enabling effective and efficient transition to hospice care, but also in maintaining nutrition to withstand oncologic therapy. We found no major difference in reintervention rates between the 2 groups but a trend toward shorter time to reintervention and stent occlusion in patients with pancreatic cancer (Table 2).…”

Covered versus uncovered metal stents for malignant gastric outlet obstruction: Systematic review and meta‐analysis

“…However, a substantial fraction of patients experiences SEMS occlusion as a result of tumor ingrowth and mucosal hyperplasia through the mesh wall . To overcome this drawback of uncovered SEMS, covered SEMS were developed, and investigators have sought the effectiveness of these stents on prolongation of stent patency . The covering membrane prevents SEMS from being embedded into the cancerous lesion or intestinal mucosa and, therefore, covered SEMS have been associated with a higher risk of migration .…”