Esophageal Stent in Acute Refractory Variceal Bleeding: A Systematic Review and a Meta-Analysis

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Hepatology

Background:

• Acute esophageal variceal bleeding is a severe complication in cirrhotic patients, with refractory cases posing life-threatening risks.
• Traditional therapies like balloon tamponade have limitations, and advanced options like TIPS or liver transplantation are not universally accessible.
• Self-expandable metal stents (SEMSs) have emerged as a potential management strategy for refractory variceal bleeding.

Purpose of the Study:

• To evaluate the effectiveness and safety of using SEMSs in managing patients with refractory esophageal variceal bleeding.
• To synthesize existing evidence through a meta-analysis of relevant studies.

Main Methods:

• A systematic literature search was conducted across MEDLINE, EMBASE, and Cochrane Library databases up to October 2022.
• Included studies involved patients over 18 years old with at least 10 participants, focusing on esophageal stents for variceal bleeding.
• A DerSimonian-Laird random-effects meta-analysis was performed using R statistical software.

Main Results:

• The meta-analysis included 12 studies with 225 patients, utilizing 228 SEMSs.
• Immediate bleeding control was achieved in 91% of cases, with a rebleeding rate of 17%.
• Adverse events included stent ulceration (7%) and migration (18%), with an overall all-cause mortality rate of 38%.

Conclusions:

• SEMSs demonstrate significant effectiveness in controlling acute refractory esophageal variceal bleeding.
• SEMSs are recommended as a salvage therapy after failure of endoscopic band ligation and sclerotherapy.
• SEMSs can serve as a vital bridge to more definitive treatments like TIPS or liver transplantation.