Published online Apr 16, 2019. doi: 10.4253/wjge.v11.i4.271
Peer-review started: February 18, 2019
First decision: February 26, 2019
Revised: March 11, 2019
Accepted: April 8, 2019
Article in press: April 9, 2019
Published online: April 16, 2019
Processing time: 59 Days and 14.7 Hours
Self-expanding metal stents are one of the palliative treatment modalities to relieve dysphagia and to improve quality of life in patients with unresectable esophageal cancer involving the gastroesophageal junction and gastric cardia. Although the quality of life improves after stent placement, it is severely limited by gastroesophageal reflux disease (GERD) especially when stent is placed across the gastroesophageal junction. To improve GERD, anti-reflux stents with valve have been designed and studied in many randomized controlled trials. However, the results from these studies are mixed. The main purpose of this study is to identify how effective is anti-reflux stent in improving gastroesophageal reflux and dysphagia when compared to standard stent.
Gastroesophageal reflux is one of the most common adverse outcomes after placement of esophageal stent in esophageal cancer involving the gastroesophageal junction and gastric cardia. Effective anti-reflux stents needs to be designed to overcome the problem of gastroesophageal reflux.
The main objective of this meta-analysis was to assess the efficacy of anti-reflux stents in improving GERD. During data gathering and analysis, authors realized that many randomized controlled trials which compared anti reflux stent and standard stents were under powered. So, more randomized controlled trials with larger number of patients are needed.
Literature search was done using electronic database to gather data for this meta-analysis where we analyzed the efficacy and safety of anti-reflux stent and standard stent. We collected data focusing on the indication for stents, material and type of stent used, demographics of patient, endoscopic technique, type of sedation used. Gastroesophageal reflux and dysphagia improvement score were our primary outcomes. Bleeding risk, stent migration risk, and stent occlusion were our secondary outcome.
There was no difference in terms of GERD score and dysphagia score between anti reflux stent and standard stent. The complications such as bleeding, stent migration, and stent occlusion were also similar between anti reflux and standard stent. Our study showed a favorable trend for anti-reflux stent to improve GERD score, though it was not statistically significant. We believe that further randomized controlled trials with larger number of patients might be helpful to ascertain if anti reflux stent indeed improves GERD score compared to standard stent.
Anti-reflux stent is not superior to standard stent in preventing GERD related to stent placement. The risk of adverse outcomes of bleeding related to stent, stent migration and stent occlusion was also comparable between anti reflux and standard stent. Both anti reflux stent and standard stent are similar in efficacy and safety. Either stent could be selected as a palliative treatment modality to relieve dysphagia in unresectable esophageal cancer. There is no difference between anti reflux stent and standard stent to prevent GERD due to stent placement across the gastroesophageal junction. Few randomized controlled trials at present suggest that anti reflux stent improve GERD related to stent placement across the gastroesophageal junction. The result from this meta-analysis did not show significant statistical difference between anti reflux stent and standard stent in terms of improving GERD score. Clinicians can choose either stent sto treat dysphagia related to esophageal cancer.
This meta-analysis showed that there are no difference in terms of safety and efficacy between anti reflux stent and standard stent. We should focus towards betterment of safety and efficacy of newer esophageal stents. More randomized clinical trials comparing the standard and anti-reflux stents are needed to further characterize their safety and efficacy.