title: Evidence-based choice of esophageal stent for the palliative management of malignant dysphagia.
abstract: BACKGROUND
  The type of stent used for the management of patients with malignant dysphagia is chosen according to subjective physician's preference. There is no recent study available to provide updated evidence on early outcomes related to the use of different types of stents.
  
  
  METHODS
  A literature search was performed using Embase, MEDLINE, Cochrane Library, and Google Scholar databases for comparative studies assessing different types of stents. The primary end point was stent-related mortality; secondary end points included: stent-related morbidity, successful palliation of dysphagia, and 30-day mortality. A random-effects model was used and heterogeneity was assessed.
  
  
  RESULTS
  Twelve studies that included 911 patients compared metallic (46.54%) and plastic stents (53.45%), and eight studies that included 564 patients compared covered (43.26%) and uncovered metal stents (56.73%). Meta-analysis of randomized, controlled trials showed that metallic stents were associated with significantly reduced stent-related mortality (1.7% vs. 11.1% for the plastic group, odds ratio (OR), 0.2; 95% confidence interval (CI), 0.06-0.74; P = 0.02), morbidity in the form of reduced esophageal perforation (1.4% vs. 9.4% for plastic stent, OR, 0.27; 95% CI, 0.08-0.89; P = 0.03), and stent migration, yet increased rate of tumor in-growth (13% vs. 1.6% for plastic stents, OR, 4.84; 95% CI, 0.99-23.76; P = 0.05). Covered metallic stents had significantly less tumor in-growth than the uncovered and an increased migration rate. There was no significant difference between metallic and plastic stents in terms of any other stent-related morbidity and 30-day mortality.
  
  
  CONCLUSIONS
  Self-expanding metallic stents are superior to plastic stents in terms of stent insertion-related mortality, morbidity, and quality of palliation. The uncovered variety is disadvantaged by high rate of tumor in-growth; adequately designed randomized, controlled trials need to examine outcomes and cost-effectiveness of covered versus uncovered metallic stents.
authors.affiliation: Imperial College of Science, Technology and Medicine, Department of Bio-surgery and Surgical Technology, St Mary's Hospital, London, W2 1NY, UK.
authors.forename: Danny
authors.initials: D
authors.lastname: Yakoub
authors.forename: Ramy
authors.initials: R
authors.lastname: Fahmy
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: Afshin
authors.initials: A
authors.lastname: Alijani
authors.forename: Christopher
authors.initials: C
authors.lastname: Rao
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: George B
authors.initials: GB
authors.lastname: Hanna
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D015201:Meta-Analysis as Topic; D010166:Palliative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D015607:Stents