Han L, Peck EW, Teo E, See KC. Systematic review comparing the efficacy and safety of covered and uncovered self-expanding metal stents in benign airway stenosis. World J Meta-Anal 2025; 13(1): 100176 [DOI: 10.13105/wjma.v13.i1.100176]
Corresponding Author of This Article
Kay Choong See, Associate Professor, Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Level 10, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore. kaychoongsee@nus.edu.sg
Research Domain of This Article
Respiratory System
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Meta-Anal. Mar 18, 2025; 13(1): 100176 Published online Mar 18, 2025. doi: 10.13105/wjma.v13.i1.100176
Systematic review comparing the efficacy and safety of covered and uncovered self-expanding metal stents in benign airway stenosis
Luke Han, Ern Wei Peck, Elizabeth Teo, Kay Choong See
Luke Han, Ern Wei Peck, Elizabeth Teo, Yong Loo Li School of Medicine, National University of Singapore, Singapore 117597, Singapore
Kay Choong See, Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore
Author contributions: Han L and Peck EW contributed to the data collection; Teo E performed the data analysis; Han L, Peck EW, Teo E, and See KC contributed to the writing of this manuscript; All co-authors read and approved the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kay Choong See, Associate Professor, Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Level 10, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore. kaychoongsee@nus.edu.sg
Received: August 9, 2024 Revised: January 11, 2025 Accepted: January 21, 2025 Published online: March 18, 2025 Processing time: 217 Days and 2.5 Hours
Abstract
BACKGROUND
Current United States Food and Drug Administration (FDA) guidelines established since 2005 recommend the usage of silicone stents over metal stents due to the risk of complications associated with the older generation of uncovered stents. Yet, with the advancement of technology, novel innovations of self-expanding metal stents (SEMS) have revolutionized the treatment of benign airway stenosis (BAS), where the insertion of SEMS is known to be easier than silicone stents.
AIM
To compare the efficacy and safety of covered SEMS against uncovered SEMS, and thereafter propose more direct trials comparing covered SEMS against silicone stents for consideration of revision of current FDA guidelines.
METHODS
A comprehensive literature review of MEDLINE and EMBASE was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Of 3002 articles, 64 publications met the eligibility criteria with a total of 900 patients (468 covered SEMS, 432 uncovered SEMS). The collected data were analyzed using Statistical Package for the Social Sciences version 11.5.
RESULTS
Covered SEMS showed a higher success rate of insertion (98.6% vs 88.2%) and lower complication rates of infection (1.3% vs 13.2%), restenosis (1.5% vs 10.6%), stent fracture (2.6% vs 7.4%), bleeding (0% vs 5.8%), and pneumothorax (0% vs 2.8%) compared to uncovered SEMS. However, covered SEMS compared to uncovered SEMS showed higher complication rates of stent migration (12.4% vs 6.9%) and granulation tissue formation (26.5% vs 20.1%).
CONCLUSION
Our study suggests that covered SEMS are an effective, safe, and viable option in the treatment of BAS. Thus, further consideration regarding the utilization of covered SEMS over other forms of stent types is appropriate.
Core Tip: Covered self-expanding metal stents (SEMS) are viable alternatives to uncovered SEMS and silicone stents, with higher stenting success rates and less complication risks. This is a systematic review evaluating the safety and efficacy of SEMS in benign airway stenosis treatment. Our results challenge the existing guidelines that favor silicone stents and point to contemporary covered SEMS as a viable alternative in view of its increased insertion success and lower complication rates, compared to uncovered SEMS.
