A systematic review of existing evidence suggests covered metallic oesophageal stents are more effective than plastic stents in the management of oesophageal perforation and anastomotic leakage.
The study examined data from 66 eligible studies (n=1752 patients) reporting the use of metallic and plastic stents in the management of post-operative anastomotic leaks and spontaneous and iatrogenic oesophageal perforations.
Primary outcomes were technical (deploying ≥1 stent to occlude site of leakage with no evidence of leakage of contrast within 24-48 hours) and clinical success (complete healing of perforation or leakage by placement of single or multiple stents irrespective of whether the stent was left in situ or was removed).
Secondary outcomes were stent migration, perforation and erosion and mortality rates. Subgroup analysis was performed for plastic vs metallic stents and anastomotic leaks vs perforations separately.
Compared with metallic stents, plastic stents were found to have significantly higher migration rates (24% vs 16%; P=.001) and repositioning (11% vs 3%; P<.001) and lower rates of technical success (91% vs 95%; P=.032).
In patients with anastomotic leaks, plastic stents were associated with higher stent migration (26% vs 15%; P=.034), perforation (2% vs 0%; P=.013), repositioning (10% vs 0%; P<.001) and lower technical success (95% vs 100%; P=.002).
In patients with perforations only, plastic stents were associated with significantly lower technical success (85% vs 99%; P<.001).
The authors concluded that covered metallic oesophageal stents may be more effective than plastic stents. However, they stressed that the quality of evidence was generally poor and they advised that high-quality randomised trials are needed to further evaluate the best management option for oesophageal perforation and anastomotic leakage.
