A Comparison of Open Standard Esophageal Stent and Anti-reflux Stent with Valve: A Meta-Analysis of Randomized Controlled Trials

Abstract

Introduction: Esophageal cancer usually presents at a later stage with dysphagia. Stent placement is one of the palliative treatment modalities to relieve dysphagia. Gastroesophageal reflux (GERD) is one of the most common adverse outcomes associated with stents, especially in cancers involving the esophagogastric junction and gastric cardia. While traditionally standard stents (SS) have been used to relieve dysphagia, intuitively antireflux stents (ARS) may have advantage over SS for relief of dysphagia and GERD due to their design. Therefore, the aim of this study was to compare the SS and ARS in terms of their efficacy, safety and complications. Methods: Electronic databases were searched for English language randomized clinical trials (RCT) since inception through April 2018. Random effects model was used to perform meta-analysis. The major outcomes studied were the improvement in dysphagia, GERD scores, which were reported as standardized mean difference (SMD). The risk of stent migration, bleeding and obstruction were reported as odds ratio (OR). Results: A total of eight RCTs were available for inclusion in the meta-analysis. Compared to the SS, the ARS showed a trend towards reduction in the dysphagia score but it did not reach a statistical significance [Standardized mean difference (SMD): -0.33 (-0.71,0.05); P=0.09, I2: 37%]. There was no statistical difference in the GERD scores between the two types of stents [(SMD): -0.17 (-0.78,0.45); P=0.008, I2: 74%]. Compared to SS, ARS showed no statistical difference in the risk of stent migration [OR: 1.37 (0.66, 2.83); P=0.40, I2: 0 %], bleeding [OR: 1.43 (0.40, 5.13); P=0.59, I2: 0 %]. and obstruction [OR: 1.66 (0.60, 4.60); P=0.33, I2: 0 %]. Conclusion: Our meta-analysis showed that the standard stent and anti-reflux stent were similar in terms of outcomes and risk of complications. Authors believe both anti-reflux and standard stents could be used in clinical practice as per the availability of clinical expertise, cost and patient’s choice. Based on our results, more RCTs with higher number of patients need to be studied in future to compare standard versus anti-reflux stents.346_A Figure 1. Forest Plot comparing Standardized Mean Difference in Dysphagia and GERD between Anti-reflux stent and Standard stent.346_B Figure 2. Forest Plot comparing complications of stent migration, bleeding and obstruction between Anti-reflux and Standard stent