Introduction The management of benign refractory oesophageal strictures is challenging. Insertion of self-expanding removable plastic stents (SEPS) have been considered a viable alternative to serial dilatations. Since the incidence of benign refractory strictures is low a randomised clinical trial of SEPS vs serial dilatations appears impractical
Methods The Primary aim was to determine the efficacy of SEPS in the treatment of refractory oesophageal strictures. Established guidelines for the reporting of meta-analysis were followed. MEDLINE (1966-2009), EMBASE and PubMed databases were searched using keywords, “oesophageal stricture”, “oesophageal stents”, (American and British spelling used) “benign strictures” and “dysphagia”. Relevant abstracts were selected and reviewed based on a pre-defined inclusion criteria (agreed by internal consensus). The articles were independently reviewed by two authors (TT and JM). Data were collected (TT) and independently verified by a second author (JM). A meta-analysis of proportions was done and since there was significant heterogeneity in the studies the random effects model was used.
Results Of the 56 relevant abstracts 37 were excluded as they did not fit the inclusion criteria. Ten further articles were excluded after analysing the full article. Overall 295 patients from nine studies were included in the final analysis (178 males, average age 54 years, range 49–68). The aetiology of the strictures (8 studies) were as follows: post-surgical: 48, Radiation: 24, Peptic: 14, Corrosive: 87, Others: 122. The average length of the stricture (5 studies) was 4.1 cm (range 3–7). Of the 151 strictures (5 studies) 73/151 (48%) were located in the mid-oesophagus. Overall 57.7% (95% CI 40 to 74.4%) of patients were dysphagia free and 64.8% (95% CI 47.3% to 80.4%) of patients were stent free at a follow-up of 619 person years duration. The outcomes were compared based on duration of stent placement, type of stent and no: of patients in the study (see Abstract 007). In 57/295 (19%) cases stents migrated after an average duration of 17.2 days (range 2–38). There were three (1%) perforations and two (0.6%) deaths.
Conclusion SEPS for benign refractory strictures seems to have a modest benefit for long-term symptom relief. Stents migrate in 19% of cases and is associated with a mortality of <1%. A large multicentre study is needed to determine the efficacy of SEPS in these cohort of patients.