TY - JOUR
T1 - Self-expanding metal stents for acute refractory esophageal variceal bleeding
T2 - A systematic review and meta-analysis
AU - McCarty, Thomas R.
AU - Njei, Basile
N1 - Publisher Copyright:
© 2016 Japan Gastroenterological Endoscopy Society.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Background and Aim: Esophageal variceal bleeding is a severe complication of portal hypertension with significant morbidity and mortality. A substantial portion of cirrhotics fail to respond to conventional medical therapy and band ligation, necessitating alternative treatments including self-expanding metal stent (SEMS) placement for acute refractory esophageal variceal bleeding. In the present study, we carried out a systematic review and structured meta-analysis of all eligible studies to evaluate the technical feasibility, safety, clinical efficacy, and survival advantage of SEMS placement for the treatment of of acute esophageal variceal bleeding. Methods: Searches of PubMed, EMBASE, Web of Science, and the Cochrane Library databases were carried out through December 2015. Individual study proportions were transformed into a quantity using the Freeman–Tukey variant of the arcsine square root transformed proportion. Combined weighted proportions, and meta-regression were then determined. Results: The search yielded 12 studies involving n = 155 patients included in our meta-analysis. Pooled clinical success rate in achieving hemostasis within 24 h was 96% (95% CI, 0.90–1.00). Technical success for SEMS deployment endoscopically was achieved in 97% of patients (95% CI, 0.91–1.00). Total adverse events (including rebleeding after 48 h, ulceration, and stent migration) were shown in 36% of patients after SEMS placement (95% CI, 0.23–0.50). Pooled 30-day and 60-day survival rates were 68% (95% CI, 0.56–0.80) and 64% (95% CI, 0.48–0.78), respectively. Conclusion: This study demonstrated that esophageal SEMS placement is a technically feasible modality and highly efficacious in achieving hemostasis in acute esophageal variceal hemorrhage.
AB - Background and Aim: Esophageal variceal bleeding is a severe complication of portal hypertension with significant morbidity and mortality. A substantial portion of cirrhotics fail to respond to conventional medical therapy and band ligation, necessitating alternative treatments including self-expanding metal stent (SEMS) placement for acute refractory esophageal variceal bleeding. In the present study, we carried out a systematic review and structured meta-analysis of all eligible studies to evaluate the technical feasibility, safety, clinical efficacy, and survival advantage of SEMS placement for the treatment of of acute esophageal variceal bleeding. Methods: Searches of PubMed, EMBASE, Web of Science, and the Cochrane Library databases were carried out through December 2015. Individual study proportions were transformed into a quantity using the Freeman–Tukey variant of the arcsine square root transformed proportion. Combined weighted proportions, and meta-regression were then determined. Results: The search yielded 12 studies involving n = 155 patients included in our meta-analysis. Pooled clinical success rate in achieving hemostasis within 24 h was 96% (95% CI, 0.90–1.00). Technical success for SEMS deployment endoscopically was achieved in 97% of patients (95% CI, 0.91–1.00). Total adverse events (including rebleeding after 48 h, ulceration, and stent migration) were shown in 36% of patients after SEMS placement (95% CI, 0.23–0.50). Pooled 30-day and 60-day survival rates were 68% (95% CI, 0.56–0.80) and 64% (95% CI, 0.48–0.78), respectively. Conclusion: This study demonstrated that esophageal SEMS placement is a technically feasible modality and highly efficacious in achieving hemostasis in acute esophageal variceal hemorrhage.
KW - Bleeding
KW - Cirrhosis
KW - Esophageal varices
KW - Self-expanding metal stent (SEMS)
KW - Stent
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U2 - 10.1111/den.12626
DO - 10.1111/den.12626
M3 - Article
C2 - 26845490
AN - SCOPUS:84978080545
SN - 0915-5635
VL - 28
SP - 539
EP - 547
JO - Digestive Endoscopy
JF - Digestive Endoscopy
IS - 5
ER -