Efficacy and safety of esophageal stenting for esophageal perforation: a systematic review and meta-analysis.

Abstract

Background: Esophageal perforations are managed with endoscopic stenting. However, surgical repair is still employed in many centers, if they lack endoscopic services, or for complex perforations.

Methods: We searched PubMed, Scopus, and Web of Science for relevant clinical trials and observational studies. Quality assessment was evaluated according to GRADE. The studies included were assessed based on the National Heart, Lung, and Blood Institute criteria. We included the following outcomes: leak after primary repair, operative repair after endoscopic therapy, stent migration, length of hospital stay (days), and mortality. We analyzed continuous data using mean differences and 95% confidence intervals (CI), while dichotomous data were analyzed using odds ratios and 95%CI. Statistical heterogeneity was assessed using the I ² statistic.

Results: Eight studies were analyzed and found to include 95 patients with esophageal perforation. Mortality rates decreased over time from 16.3% (Abbas, 2009) to 6.7% (Heel, 2020). Re-operative procedures were highest at 51.4%(D'Cunha, 2011) and lower in later studies. Stent migration rates varied from 16.2-22.3%. Leakage rates ranged from 8.8-16.2%. Hospital stays ranged from 5.0 days (D'Cunha, 2011) to 15.3 days (Law, 2017), with significant variability across studies.

Conclusion: Esophageal stenting is considered an efficient and well-tolerated method for managing esophageal perforation.