Covered versus uncovered metal stents for malignant gastric outlet obstruction: a systematic review and meta-analysis.,Gastrointestinal Endoscopy

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Covered versus uncovered metal stents for malignant gastric outlet obstruction: a systematic review and meta-analysis.
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2020-06-18 , DOI: 10.1016/j.gie.2020.06.033
Alberto Tringali ₁ , Deborah Costa ₁ , Andrea Anderloni ₂ , Silvia Carrara ₂ , Alessandro Repici ₂ , Douglas G Adler ₃

Affiliation

Background and Aims

Self-expandable metal stents (SEMSs) are used for palliation of malignant gastric outlet obstruction (GOO). Studies comparing covered SEMSs (C-SEMSs) and uncovered SEMSs (U-SEMSs) have led to inconclusive results. We compared efficacy and safety of C-SEMSs versus U-SEMSs in patients with GOO.

Methods

We searched MEDLINE, EMBASE, and Cochrane Library from 2000 to 2019 to identify available studies comparing C-SEMSs versus U-SEMSs in patients with GOO. Primary outcomes were stent survival and patient survival, whereas secondary outcomes were clinical and technical success, Gastric Outlet Obstruction Score System (GOOSS) score after the procedure, overall adverse events, reintervention rate, dysfunction rate, stent occlusion, and stent migration.

Results

Overall, 7 randomized controlled trials and 9 observational studies were identified that included 1741 patients. C-SEMSs were associated with higher stent survival (hazard ratio, .68; 95% confidence interval [CI], .48-.96), whereas patient survival did not statistically significantly differ between C-SEMS and U-SEMS groups (hazard ratio, .96; 95% CI, .75-1.23). Clinical and technical success were not statistically different between groups (odds ratios, 1.1 [95% CI, .76-1.61] and .69 [95% CI, .21-2.3], respectively). There were no differences in terms of overall adverse events, reintervention rate, dysfunction rate, and GOOSS rate ≥2 after SEMS placement. U-SEMSs were associated with a higher rate of occlusion (odds ratio, .34; 95% CI, .21-.53) and C-SEMSs with a higher rate of migration (odds ratio, 4.28; 95% CI, 2.79-6.57).

Conclusions

C-SEMSs were associated with higher stent survival (time between stent deployment and stent dysfunction) compared with U-SEMSs, whereas no differences in terms of patient survival (time between stent deployment and patient's death) emerged. However, U-SEMSs were associated with higher risk of occlusion and C-SEMSs with higher risk of migration. Further studies using new C-SEMSs with an antimigration system are needed.

中文翻译：

覆盖与未覆盖金属支架治疗恶性胃出口梗阻：系统评价和荟萃分析。

背景和目标

自膨胀金属支架（SEMSs）用于缓解恶性胃出口梗阻（GOO）。比较涵盖的SEMS（C-SEMS）和未发现的SEMS（U-SEMS）的研究导致了不确定的结果。我们比较了C-SEMS和U-SEMS在GOO患者中的疗效和安全性。

方法

我们从2000年至2019年对MEDLINE，EMBASE和Cochrane库进行了搜索，以鉴定可用于比较GOO患者中C-SEMS和U-SEMS的可用研究。主要结局为支架生存率和患者生存率，次要结局为临床和技术成功率，手术后胃出口梗阻评分系统（GOOSS）评分，总体不良事件，再干预率，功能障碍率，支架阻塞和支架迁移。

结果

总体而言，确定了7项随机对照试验和9项观察性研究，其中包括1741例患者。C-SEMSs与较高的支架存活率相关（危险比，.68； 95％置信区间[CI] ，. 48-.96），而C-SEMS和U-SEMS组之间的患者存活率在统计学上无显着差异（危险比，.96； 95％CI，.75-1.23）。两组之间的临床和技术成功率无统计学差异（赔率分别为1.1 [95％CI，.76-1.61]和.69 [95％CI，.21-2.3]。放置SEMS后，总体不良事件，再干预率，功能障碍率和GOOSS率≥2方面无差异。U-SEMS的阻塞率较高（比值比为0.34; 95％CI为0.21-0.53），C-SEMS的迁移率较高（比值比值为4.28; 95％CI为2.79-0.95） 6.57）。