Radioactive Stent for Malignant Esophageal Obstruction: A Meta-Analysis of Randomized Controlled Trials

Yang, Zhimin; Geng, Haitao; Wu, Hong

doi:10.1089/lap.2020.0666

Cited by 12 publications

(10 citation statements)

References 20 publications

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“…The use of irradiated SEMSs has been a topic of interest that potentially provides an advantage of combining the benefits of SEMS placement and brachytherapy. Based on a meta-analysis of six RCTs, the use of irradiated SEMSs led to an increased dysphagia-free time compared with traditional SEMSs, without affecting the rate of adverse events [72]. To date, however, all of these studies have been performed in Chinese populations, thereby warranting (prospective) evaluation in Western populations.…”

Section: Combined Approachmentioning

confidence: 99%

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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Main recommendations Malignant disease 1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass.Strong recommendation, high quality evidence. 2 ESGE recommends brachytherapy as a valid alternative, alone or in addition to stenting, in esophageal cancer patients with malignant dysphagia and expected longer life expectancy.Strong recommendation, high quality evidence. 3 ESGE recommends esophageal SEMS placement for sealing malignant tracheoesophageal or bronchoesophageal fistulas. Strong recommendation, low quality evidence. 4 ESGE does not recommend SEMS placement as a bridge to surgery or before preoperative chemoradiotherapy because it is associated with a high incidence of adverse events. Other options such as feeding tube placement are preferable. Strong recommendation, low quality evidence. Benign disease 5 ESGE recommends against the use of SEMSs as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and their cost. Strong recommendation, low quality evidence. 6 ESGE suggests consideration of temporary placement of self-expandable stents for refractory benign esophageal strictures. Weak recommendation, moderate quality evidence. 7 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures because of their very low risk of embedment and ease of removability. Weak recommendation, low quality evidence. 8 ESGE recommends the stent-in-stent technique to remove partially covered SEMSs that are embedded in the esophageal wall. Strong recommendation, low quality evidence. 9 ESGE recommends that temporary stent placement can be considered for the treatment of leaks, fistulas, and perforations. No specific type of stent can be recommended, and the duration of stenting should be individualized. Strong recommendation, low quality of evidence. 10 ESGE recommends considering placement of a fully covered large-diameter SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive bleeding. Strong recommendation, moderate quality evidence.

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Section: Combined Approachmentioning

confidence: 99%

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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“…Both stent types resulted in good immediate dysphagia relief, but radioactive stent performed better at 3 and 6 months of follow-up, without significant differences in complication rates. Moreover, a more recent meta-analysis in 2020 (6 RCTs; 403 patients) compared traditional SEMS with radioactive SEMS (loaded with iodine-125 seeds) [ 44 ] and showed no significant difference between the two stent types in either the dysphagia scores or stent restenosis, migration, severe chest pain, and other complications (hemorrhage, fistula formation). However, time to restenosis and overall survival were better in the radioactive stent group [ 45 ].…”

Section: Irradiating and Drug Eluting Gastrointestinal Stentsmentioning

confidence: 99%

Futuristic Developments and Applications in Endoluminal Stenting

Ferreira‐Silva

Medas

Girotra

et al. 2022

Gastroenterology Research and Practice

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Endoscopic stenting is a well-established option for the treatment of malignant obstruction, temporary management of benign strictures, and sealing transmural defects, as well as drainage of pancreatic fluid collections and biliary obstruction. In recent years, in addition to expansion in indications for endoscopic stenting, considerable strides have been made in stent technology, and several types of devices with advanced designs and materials are continuously being developed. In this review, we discuss the important developments in stent designs and novel indications for endoluminal and transluminal stenting. Our discussion specifically focuses on (i) biodegradable as well as (ii) irradiating and drug-eluting stents for esophageal, gastroduodenal, biliary, and colonic indications, (iii) endoscopic stenting in inflammatory bowel disease, and (iv) lumen-apposing metal stent.

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“…Although both types of SEMS are associated with high rates of dysphagia improvement, recently, a novel radioactive SEMS such as the I-125 seed-loaded stent (ISS) have been developed to potentially improve the benefits. As described in two recent meta-analyses, this novel radioactive ISS provided better dysphagia improvement than conventional SEMS and other therapies [32,33].…”

Section: Sems-nv Sems-v Risk Diff Erence Risk Diff Erence Study or Su...mentioning

confidence: 68%

Anti-reflux versus conventional self-expanding metal stents in the palliation of esophageal cancer: A systematic review and meta-analysis

et al. 2022

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BACKGROUND AND AIMS: Self-expanding metal stents (SEMS) are an effective palliative endoscopic therapy to reduce dysphagia in esophageal cancer. Gastroesophageal reflux disease (GERD) is a relatively common complaint after non-valved conventional self-expanding metal stent placement. Therefore, valved self-expanding metal stents (SEMS-V) were designed to reduce the rate of GERD symptoms. We aim to perform a systematic review and meta-analysis comparing the two stents. MATERIAL AND METHODS: This is a systematic review and meta-analysis including only randomized clinical trials (RCT) comparing the outcomes between SEMS-V and non-valved self-expanding metal stents (SEMS-NV) following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were analyzed with the Review Manager Software. Quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation guidelines. RESULTS: Ten randomized clinical trials including a total of 467 patients, 234 in the SEMS-V group and 233 in the SEMS-NV group, were included. There were no statistically significant differences regarding GERD qualitative analysis (RD -0.17; 95% CI -0.67, 0.33; p = 0.5) and quantitative analysis (SMD -0.22; 95% CI -0.53, 0.08; p = 0.15) technical success (RD -0.03; 95% CI -0.07, 0.01; p = 0.16), dysphagia improvement (RD -0.07; 95% CI -0.19, 0.06; p = 0.30), and adverse events (RD 0.07; 95% CI -0.07, 0.20; p = 0.32). CONCLUSION: Both SEMS-V and SEMS-NV are safe and effective in the palliation of esophageal cancer with similar rates of GERD, dysphagia relief, technical success, adverse events, stent migration, stent obstruction, bleeding, and improvement of the quality of life.

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Radioactive Stent for Malignant Esophageal Obstruction: A Meta-Analysis of Randomized Controlled Trials

Cited by 12 publications

References 20 publications

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Futuristic Developments and Applications in Endoluminal Stenting

Anti-reflux versus conventional self-expanding metal stents in the palliation of esophageal cancer: A systematic review and meta-analysis

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