Complications of stent placement in patients with esophageal cancer: A systematic review and network meta-analysis

Abstract

Background: Palliative treatments and stents are necessary for relieving dysphagia in patients with esophageal cancer. The aim of this study was to simultaneously compare available treatments in terms of complications.

Methods: Web of Science, Medline, Scopus, Cochrane Library and Embase were searched. Statistical heterogeneity was assessed using the Chi2 test and was quantified by I2. The results of this study were summarized in terms of Risk Ratio (RR). The random effects model was used to report the results. The rank probability for each treatment was calculated using the p-score.

Results: Out of 17855 references, 24 RCTs reported complications including treatment related death (TRD), bleeding, stent migration, aspiration, severe pain and fistula formation. In the ranking of treatments, thermal ablative therapy (p-score = 0.82), covered Evolution® stent (p-score = 0.70), brachytherapy (p-score = 0.72) and antireflux stent (p-score = 0.74) were better treatments in the network of TRD. Thermal ablative therapy (p-score = 0.86), the conventional stent (p-score = 0.62), covered Evolution® stent (p-score = 0.96) and brachytherapy (p-score = 0.82) were better treatments in the network of bleeding complications. Covered Evolution® (p-score = 0.78), uncovered (p-score = 0.88) and irradiation stents (p-score = 0.65) were better treatments in network of stent migration complications. In the network of severe pain, Conventional self-expandable nitinol alloy covered stent (p-score = 0.73), polyflex (p-score = 0.79), latex prosthesis (p-score = 0.96) and brachytherapy (p-score = 0.65) were better treatments.

Conclusion: According to our results, thermal ablative therapy, covered Evolution® stents, brachytherapy, and antireflux stents are associated with a lower risk of TRD. Moreover, thermal ablative therapy, conventional, covered Evolution® and brachytherapy had lower risks of bleeding. Overall, fewer complications were associated with covered Evolution® stent and brachytherapy.

Fig 1. A flow chart depicting the stages of retrieving articles and checking the eligibility criteria for network meta-analysis.

Fig 2

Network of stent interventions for palliative treatments that had reported TRD in esophageal cancer; A: the metallic stent is a reference treatment, B: Ultraflex is a reference, C: Brachytherapy is a reference, and D: Antireflux is a reference.

Fig 3

Forest plots for TRD in networks A, B, C, & D. Metallic stent, Ultraflex, Brachytherapy, and Antireflux are reference treatments in networks A, B, C & D, respectively.

Fig 4

The network of stent interventions for palliative treatments that reported the bleeding complication in esophageal cancer; A: metallic stent is a reference treatment, B: Conventional is a reference, C: Ultraflex is a reference, and D: Brachytherapy is a reference treatment. CSENACS: Conventional self-expandable nitinol alloy covered stent.

Fig 5

Forest plots for bleeding complication in networks A, B, C & D. Metallic stent, Conventional stent, Ultraflex, and Brachytherapy are reference treatments in networks A, B, C & D, respectively.