A Systematic Review and Meta-Analysis of Factors Associated with Esophageal Stent Migration and a Comparison of Anti-Migration Techniques.

Abstract

Background: Esophageal stents are efficacious in managing many different pathologies. However, they are limited by their common complication of migration. We present the largest comprehensive review of the risk factors associated with stent migration and interventions leveraged to prevent it.

Methods: A systematic review was conducted following PRISMA guidelines. Inclusion criteria were primary data sources (no systematic reviews), ≥18 years of age, esophageal stent placement, and reported indication for intervention, site of placement, and migration rate. 162 papers met this criterion. Proportions experiencing migration were pooled using a random effects model with a DerSimonian-Laird estimator to account for potential heterogeneity and forest plots were used to visualize the treatment effects across studies.

Results: There were 14,092 patients included in the analysis. The mean migration rate across all studies and stent types was 17.2% and the mean reintervention rate was 83.2%. Cancerous indications, benign strictures, history of esophageal surgery, stent diameter <20mm, plastic stents, and fully covered stents were associated with significantly higher migration rates. There was a trend towards stents using anti-migration technology having lower migration rates (effect size (ES)=0.15, 95% confidence interval (CI) 0.10-0.20) compared to those that did not (ES=0.33, 95% CI 0.18-0.48), however this difference was not significant. There were no statistically significant differences between stent fixation strategies (clips, sutures, wire hooks, Shim's technique).

Conclusion: There are several risk factors associated with stent migration; however no current solutions confer significantly reduced stent migration. Further optimization of these devices or creation of new technology to prevent migration is indicated.