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Critical Appraisal of the Impact of Oesophageal Stents in the Management of Oesophageal Anastomotic Leaks and Benign Oesophageal Perforations: An Updated Systematic Review

  • Sivesh K. Kamarajah
  • James Bundred
  • Gary Spence
  • Andrew Kennedy
  • Bobby V. M. Dasari
  • Ewen A. GriffithsEmail author
Scientific Review

Abstract

Introduction

Endoscopic placement of oesophageal stents may be used in benign oesophageal perforation and oesophageal anastomotic leakage to control sepsis and reduce mortality and morbidity by avoiding thoracotomy. This updated systematic review aimed to assess the safety and effectiveness of oesophageal stents in these two scenarios.

Methods

A systematic literature search of all published studies reporting use of metallic and plastic stents in the management of post-operative anastomotic leaks, spontaneous and iatrogenic oesophageal perforations were identified. Primary outcomes were technical (deploying ≥ 1 stent to occlude site of leakage with no evidence of leakage of contrast within 24–48 h) and clinical success (complete healing of perforation or leakage by placement of single or multiple stents irrespective of whether the stent was left in situ or was removed). Secondary outcomes were stent migration, perforation and erosion, and mortality rates. Subgroup analysis was performed for plastic versus metallic stents and anastomotic leaks versus perforations separately.

Results

A total of 66 studies (n = 1752 patients) were included. Technical and clinical success rates were 96% and 87%, respectively. Plastic stents had significantly higher migration rates (24% vs 16%, p = 0.001) and repositioning (11% vs 3%, p < 0.001) and lower technical success (91% vs 95%, p = 0.032) than metallic stents. In patients with anastomotic leaks, plastic stents were associated with higher stent migration (26% vs 15%, p = 0.034), perforation (2% vs 0%, p = 0.013), repositioning (10% vs 0%, p < 0.001), and lower technical success (95% vs 100%, p = p = 0.002). In patients with perforations only, plastic stents were associated with significantly lower technical success (85% vs 99%, p < 0.001).

Conclusions

Covered metallic oesophageal stents appear to be more effective than plastic stents in the management of oesophageal perforation and anastomotic leakage. However, quality of evidence of generally poor and high-quality randomised trial is needed to further evaluate best management option for oesophageal perforation and anastomotic leakage.

Notes

Supplementary material

268_2019_5259_MOESM1_ESM.docx (899 kb)
Supplementary material 1 (DOCX 899 kb)

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© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman HospitalNewcastle University NHS Foundation Trust HospitalsNewcastle upon TyneUK
  2. 2.Institute of Cellular MedicineUniversity of NewcastleNewcastle upon TyneUK
  3. 3.College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
  4. 4.Division of Gastroenterology and SurgeryUlster HospitalBelfastUK
  5. 5.Department of Upper Gastro-Intestinal Surgery, Belfast City HospitalBelfast Health and Social Care TrustBelfastUK
  6. 6.Department of Hepatobiliary, Pancreatic and Transplant SurgeryQueen Elizabeth Hospital BirminghamBirminghamUK
  7. 7.Department of Upper Gastrointestinal SurgeryUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
  8. 8.Institute of Cancer and Genomic Sciences, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK

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