title: Hemostasis in uncontrolled esophageal variceal bleeding by self-expanding metal stents: a systematic review.
abstract: OBJECTIVE
  The aim of this systematic review was to evaluate the current reported efficacy and the mortality rate of SEMS treatment in uncontrolled bleeding patients.
  
  
  BACKGROUND
  Esophageal variceal bleeding (EVB) represents a life threatening pathology. Despite the adequate pharmacologic and endoscopic treatment, continuous or recurrent bleeding, named as uncontrolled bleeding, occurs in 10-20% of cases. A new removable, covered, and self-expanding metal stent (SEMS) was proposed to control the variceal bleeding.
  
  
  METHODS
  The study was conducted according to the PRISMA statement. Studies were identified by searching MEDLINE (1989-present) and SCOPUS (1989-present) databases. The last search was run on 01 July 2015.
  
  
  RESULTS
  Nine studies (period range=2002-2015) met the inclusion criteria and were included in quantitative analysis. High rate of SEMS efficacy in controling acute bleeding was observed, with a reported percentage ranging from 77.7 to 100%. In 10% to 20% of patients, re-bleeding occurred with SEMS in situ. Stent deployment was successful in 77.8% to 100% of patients while 11 to 36.5% of patients experienced stent migration.
  
  
  CONCLUSIONS
  SEMS could be effective and safe in control EVB and can be proposed as a reliable option to ballon tamponed for patient stabilization and as a bridging to other therapeutic approach.
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pontone
authors.affiliation: Department of Clinical Medicine, "Sapienza" University of Rome, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Giusto
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Filippini
authors.affiliation: Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy.
authors.forename: Clelia
authors.initials: C
authors.lastname: Cicerone
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Pironi
authors.affiliation: Department of Clinical Medicine, "Sapienza" University of Rome, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Merli
keywords: Endoscopic band ligation; Nonselective β-blockers; Self-expanding metal stent; TIPSS; Uncontrolled bleeding