Covered versus uncovered metal stents for malignant gastric outlet obstruction

Post written by Alberto Tringali, MD, Deborah Costa, MD, Andrea Anderloni, MD, Silvia Carrara, MD, Alessandro Repici, MD, and Douglas G. Adler, MD, from the Endoscopy Unit, Conegliano Hospital Italy, Conegliano, Italy, the Endoscopy Unit, Humanitas Hospital, Milan, Italy, and the Division of Gastroenterology and Hepatology, University of Utah Hospital, Salt Lake City, Utah, USA.

The focus of this study was to compare the efficacy and safety of  C-SEMS vs U-SEMS in patients with malignant gastric outlet obstruction. The use of U-SEMS is associated with a higher risk of tumor ingrowth and mucosal hyperplasia, while C-SEMS were developed to overcome the limitations of U-SEMS and prolong the stent patency. Unfortunately, C-SEMS are associated with higher risk of migration, reducing the effectiveness of these stents. Previous comparison studies between C-SEMS and U-SEMS have not given definitive results.

Overall, 7 RCTs and 9 observational studies were identified, including 1741 patients. C-SEMS were associated with higher stent survival (HR=0.68, 95% CI, 0.48-0.96) while patient survival did not statistically significantly differ between C-SEMS and U-SEMS groups (HR=0.96, 95% CI, 0.75-1.23). Clinical and technical success were not statistically different between groups (OR 1.1, 95% CI, 0.76-1.61; OR 0.69, 95% CI, 0.21-2.3). There were no differences in terms of overall adverse events, reintervention rate, dysfunction rate, GOOSS rate ≥2 after SEMS placement (OR 1.12; 95% CI, 0.76-1.66; OR 1.06; 95% CI, 0.69-1.63; OR 1.00; 95% CI, 0.72-1.38; OR 1.39; 95% CI, 0.90-2.15). U-SEMS were associated with higher rate of occlusion (OR 0.34; 95% CI, 0.21-0.53), while C-SEMS with higher rate of migration(OR 4.28; 95% CI, 2.79-6.57).

In this meta-analysis, C-SEMS had a higher stent patency compared to U-SEMS, without other differences in overall patient survival. Our study is unique in that we reported stent survival and patient survival as a time to event variable (Hazard ratio), unlike a previous meta-analyses on this topic. Technical and clinical success did not differ between the 2 groups. These data are applicable mostly to gastric cancer (65% of our data), thus our results are not generalizable to patients with pancreatic tumor-related GOO. RCTs assessing the role of different types of self-expandable metallic stents in cases of gastric outlet obstruction related to pancreatic cancer is warranted.


Read the full article online.

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