To analyze the outcomes of self-expandable
stent placement for benign esophageal
strictures and benign esophageal leaks in the literature.
METHODS: The PubMed, Embase and Cochrane databases were searched for relevant articles published between January 2000 and July 2014. Eight prospective studies were identified that analyzed the outcomes of
stent placement for refractory benign esophageal
strictures. The outcomes of
stent placement for benign esophageal leaks, perforations and fistulae were extracted from 20 retrospective studies that were published after the inclusion period of a recent systematic review. Data were pooled and analyzed using descriptive statistics.
RESULTS: Fully covered
self-expandable metal stents (FC SEMS) (n = 85), biodegradable (BD)
stents (n = 77) and self-expandable
plastic stents (SEPS) (n = 70) were inserted in 232 patients with refractory benign esophageal
strictures. The overall clinical success rate was 24.2% and according to
stent type 14.1% for FC SEMS, 32.9% for BD
stents and 27.1% for SEPS.
Stent migration occurred in 24.6% of cases. The overall complication rate was 31.0%, including major (17.7%) and minor (13.4%) complications. A total of 643 patients were treated with self-expandable
stents mainly for postsurgical leaks (64.5%), iatrogenic perforations (19.6%),
Boerhaave's syndrome (7.8%) and fistulae (3.7%). FC SEMS and partially covered SEMS were used in the majority of patients. Successful closure of the defect was achieved in 76.8% of patients and according to etiology in 81.4% for postsurgical leaks, 86.0% for perforations and 64.7% for fistulae. The pooled
stent migration rate was 16.5%.
Stent-related complications occurred in 13.4% of patients, including major (7.8%) and minor (5.5%) complications.
CONCLUSION: The outcomes of
stent placement for refractory benign esophageal
strictures were poor. However, randomized trials are needed to put this into perspective. The evidence on successful
stent placement for benign esophageal leaks, perforations and fistulae is promising.