Both authors contributed equally to this manuscript.
Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus
Article first published online: 24 APR 2011
© 2011 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 33, Issue 12, pages 1292–1301, June 2011
How to Cite
van Boeckel, P. G. A., Sijbring, A., Vleggaar, F. P. and Siersema, P. D. (2011), Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Alimentary Pharmacology & Therapeutics, 33: 1292–1301. doi: 10.1111/j.1365-2036.2011.04663.x
This uncommissioned systematic review was subject to full peer-review.
- Issue published online: 16 MAY 2011
- Article first published online: 24 APR 2011
- Publication data Submitted 22 November 2010 First decision 2 January 2011 Resubmitted 30 March 2011 Accepted 31 March 2011
Background Placement of self-expanding metal stents (SEMS) or plastic stents (SEPS) has emerged as a minimally invasive treatment option for benign oesophageal ruptures and leaks; however, it is not clear which stent type should be preferred.
Aim To assess clinical effectiveness and safety of treating benign oesophageal ruptures and anastomotic leaks with temporary placement of a stent with special emphasis on different stent designs.
Methods A pooled analysis was performed after searching PubMed and EMBASE databases for studies regarding placement of fully covered and partially covered SEMS (FSEMS and PSEMS) and SEPS for this indication. Data were pooled and evaluated for clinical outcome, complications and survival.
Results Twenty-five studies, including 267 patients with complete follow-up on outcome, were identified. Clinical success was achieved in 85% of patients and was not different between stent types (SEPS 84%, FSEMS 85% and PSEMS 86%, P = 0.97). Time of stent placement was longest for SEPS (8 weeks) followed by FSEMS and PSEMS (both 6 weeks). In total, 65 (34%) patients had a stent-related complication. Stent migration occurred more often with SEPS [n = 47 (31%)] and FSEMS [n = 7 (26%)] than with PSEMS [n = 2 (12%), P ≤ 0.001], whereas there was no significant difference in tissue in- and overgrowth between PSEMS [12% vs. 7% (FSEMS) and 3% (SEPS), P = 0.68].
Conclusions Although there is a lack of randomised controlled trials, it seems that covered stent placement for a period of 6–8 weeks is safe and effective for benign oesophageal ruptures and anastomotic leaks to heal. As efficacy between different stent types is not significantly different, stent choice should depend on expected risk of stent migration (self-expanding plastic stents and fully covered self-expanding metal stents) and, to a minor degree, on expected risk of tissue in- or overgrowth (partially covered self-expanding metal stents).