The use of self-expanding metallic stents in the management of benign colonic obstruction: a systematic review and meta-analysis.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2024-07-19 DOI:10.1007/s10151-024-02959-7

Armin Fardanesh, Jayan George, Daniel Hughes, Stavroula Stavropoulou-Tatla, Pawan Mathur

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引用次数: 0

Abstract

Introduction: Patients presenting with large bowel obstruction (LBO) frequently undergo emergency surgery that is associated with significant morbidity. In malignant LBO, endoscopic approaches with placement is a self-expanding metal stent (SEMS), have been proposed to prevent emergency surgery and act as a bridge to an elective procedure-with the intention of avoiding a stoma and reducing morbidity. This systematic review aims to assess the quality and outcomes of data available on the use of SEMS in benign causes of colonic obstruction.

Methods: This systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the protocol was registered on Prospero (ID: CRD42021239363). PUBMED, MEDLINE, HMIC, CINAHL, AMED, EMBASE, APA and Cochrane databases were searched. Studies were assessed for quality utilising the MINORS criteria. Pooled odds ratios with 95% confidence intervals (95% CI) were calculated using random effects models.

Results: Sixteen studies were included for analysis. 300 patients were included with an average age of 68, and a male predominance of 57%. The quality of the papers included were at risk of bias. The pooled rate of technical success of procedure was 94.4% (95% CI 90.5-96.8%) The pooled rate of clinical success was 77.6% (95% CI: 66.6-85.7%). Adverse effects were low, with perforation 8.8% (4.5-16.6%), recurrence 26.5% (17.2-38.5%) and stent migration 22.5% (14.1-33.8%).

Discussion: This systematic review demonstrated that SEMS for benign colonic obstruction can be a safe and successful procedure. The utilisation of SEMS in malignant disease as a bridge to surgery has been well documented. Whilst the limitations of the data interpreted are appreciated, we postulate that SEMS could be utilised to decompress patients acutely and allow pre-operative optimisation, leading to a more elective surgery with less subsequent morbidity.

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使用自膨胀金属支架治疗良性结肠梗阻：系统综述和荟萃分析。

简介：大肠梗阻（LBO）患者经常需要接受急诊手术，而急诊手术会导致严重的发病率。对于恶性大肠梗阻，有人建议采用放置自膨胀金属支架（SEMS）的内窥镜方法来防止急诊手术，并为择期手术架起桥梁--目的是避免造口并降低发病率。本系统性综述旨在评估 SEMS 用于良性结肠梗阻的数据质量和结果：本系统综述采用系统综述和荟萃分析首选报告项目（PRISMA）指南进行，综述方案已在 Prospero 上注册（ID：CRD42021239363）。检索了 PUBMED、MEDLINE、HMIC、CINAHL、AMED、EMBASE、APA 和 Cochrane 数据库。根据 MINORS 标准对研究进行了质量评估。采用随机效应模型计算汇总的几率比和 95% 置信区间 (95%CI)：共纳入 16 项研究进行分析。共纳入 300 名患者，平均年龄为 68 岁，男性占 57%。所纳入论文的质量存在偏倚风险。手术技术成功率为 94.4%（95% CI：90.5-96.8%），临床成功率为 77.6%（95% CI：66.6-85.7%）。不良反应较低，穿孔率为 8.8%（4.5-16.6%），复发率为 26.5%（17.2-38.5%），支架移位率为 22.5%（14.1-33.8%）：本系统综述表明，SEMS 治疗良性结肠梗阻是一种安全、成功的手术。在恶性疾病中使用 SEMS 作为手术的桥梁已得到充分证实。虽然我们了解所解释的数据存在局限性，但我们推测 SEMS 可用于为患者进行急性减压，并进行术前优化，从而使手术更具选择性，降低后续发病率。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.