Self-expanding metal stents for acute refractory esophageal variceal bleeding: A systematic review and meta-analysis

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.