Success rates of fixation techniques on prevention of esophageal stent migration: a systematic review and meta-analysis

Abstract

Background and study aims: Esophageal stenting (ES) is an important intervention for the management of malignant and benign dysphagia, with migration representing a common drawback. This systematic review with meta-analysis aimed to assess the benefit of ES fixation over non-fixated stenting. Patients Methods: A systematic research was performed in MEDLINE, Cochrane, Scopus and ClinicalTrials.gov databases until January 2023 for comparative studies evaluating the migration rates of ES after anchoring or not. The primary outcome included the difference of migration rates for fixated and non-fixated ES, with the rate of adverse events being secondary outcome. A subgroup analysis stratified the results based on different fixation techniques; suturing, over the scope clipping (OTSC) and trough the scope clipping (TTSC). Meta-analyses were based on random effects model and the results were reported as odds ratios (OR), with 95% Confidence Intervals (95%CI). Results: Ten studies (1014 patients) were included. The rates of stent migration were significantly lower after fixation [OR=0.20 (95%CI: 0.11-0.37; I2=59%, p=0.01)]. The rates of complications were similar between the fixation and control groups [OR=0.65 (95%CI: 0.28-1.52; I2=55%, p=0.06)]. In the subgroup analysis, all anchoring techniques preserved the superiority over non-fixated stents [suturing OR= 0.23 (95%CI: 0.10-0.53); OTSC OR= 0.31 (95%CI: 0.17- 0.58); TTSC OR=0.10 (95%CI: 0.03-0.38)], however only OTSC and TTSC groups achieved non-significant heterogeneity (I2=0%, p=0.67 and p=0.73, respectively). No difference between techniques was recorded considering the migration rates. Conclusion: Esophageal stent fixation is associated with significantly lower migration rates compared to the non-fixated stents regardless type and stenting indication.

Suspension of Esophageal Stent: An Endoscopic Technique for the Treatment of Esophagopleural Fistula

“…Endoscopic suturing requires more specific technique training; the tangential working angle makes adequate suture depth challenging. 3 Specific cutting instruments are generally required for OTSC fragmentation and retrieval. 5 Some novel and advanced endoscopic instruments may not be available in some institutions, especially those in remote areas.…”