A Repici1, C Hassan, P Sharma, M Conio, P Siersema. 1. Gastroenterology Department, Digestive Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Milano, Italy. alessandro.repici@humanitas.it
Abstract
BACKGROUND: Treatment of refractory or recurrent benign oesophageal strictures is demanding and surgery may be the only available option. The role of self-expanding plastic stents (SEPS) in the treatment of these strictures is still controversial because of the conflicting results of various studies. AIM: To analyse with regard to SEPS: technical and clinical success, factors associated with outcome, and safety. METHODS: Pooled-data analysis of a systematic review of the literature. Clinical success was defined as no need for further endoscopic or surgical treatment after SEPS removal. RESULTS: Data of 10 studies with 130 treated patients were included. SEPS insertion was technically successful in 128 of 130 patients (98%, 95% CI = 96-100%). Clinical success was achieved in 68 patients (52%, 95% CI = 44-61%) and this was found to be lower in those with a cervical localization of the stricture (33% vs. 54%; P < 0.05). Early (<4 weeks) migration of the stent was reported in 19 (24%, 95% CI = 14-32%) cases, while post-insertion endoscopic re-intervention was required in 25 (21%, 95% CI = 14-28%). Major clinical complications occurred in 12 patients (9%, 95% CI = 4-14%), resulting in death of one (0.8%) patient. CONCLUSIONS: Our pooled-data analysis showed a favourable risk/benefit ratio when SEPS are applied in patients with recurrent or refractory benign oesophageal strictures. This supports the use of SEPS before referring patients to surgery, and they are a valuable alternative to repeat endoscopic dilation.
BACKGROUND: Treatment of refractory or recurrent benign oesophageal strictures is demanding and surgery may be the only available option. The role of self-expanding plastic stents (SEPS) in the treatment of these strictures is still controversial because of the conflicting results of various studies. AIM: To analyse with regard to SEPS: technical and clinical success, factors associated with outcome, and safety. METHODS: Pooled-data analysis of a systematic review of the literature. Clinical success was defined as no need for further endoscopic or surgical treatment after SEPS removal. RESULTS: Data of 10 studies with 130 treated patients were included. SEPS insertion was technically successful in 128 of 130 patients (98%, 95% CI = 96-100%). Clinical success was achieved in 68 patients (52%, 95% CI = 44-61%) and this was found to be lower in those with a cervical localization of the stricture (33% vs. 54%; P < 0.05). Early (<4 weeks) migration of the stent was reported in 19 (24%, 95% CI = 14-32%) cases, while post-insertion endoscopic re-intervention was required in 25 (21%, 95% CI = 14-28%). Major clinical complications occurred in 12 patients (9%, 95% CI = 4-14%), resulting in death of one (0.8%) patient. CONCLUSIONS: Our pooled-data analysis showed a favourable risk/benefit ratio when SEPS are applied in patients with recurrent or refractory benign oesophageal strictures. This supports the use of SEPS before referring patients to surgery, and they are a valuable alternative to repeat endoscopic dilation.