Systematic review: Temporary stent placement for benign ruptures or anastomotic leaks with special emphasis on stent type

Background: Placement of self-expanding metal stents (SEMS) or plastic stents (SEPS) has emerged as a minimally invasive treatment option for benign esophageal ruptures and leaks; however, it is not clear which stent type should be preferred. Aim & Methods: A pooled analysis was performed after searching PubMed and EMBASE databases for studies regarding placement of fully covered and partially covered SEMS (FSEMS and PSEMS) and SEPS for this indication. Data were pooled and evaluated for clinical outcome, complications and survival. Results: Twenty-five studies, including 267 patients with complete follow-up on outcome were identified. Clinical success was achieved in 85% of patients and was not different between stent types (SEPS 84%,FSEMS 85% and PSEMS 86%,p=0.97). Time of stent placement was longest for SEPS (8 weeks) followed by FSEMS and PSEMS (both 6 weeks). In total 65 (34%) patients had a stent related complication. Stent migration occurred more often with SEPS (n=47(31%)) and FSEMS (n=7(26%)) than with PSEMS (n=2 (12%),p= <0.001), while there was no significant difference in tissue in- and overgrowth between PSEMS (12% vs.7% (FSEMS) and 3% (SEPS),p=0.68). Conclusion: Although there is a lack of randomized controlled trials, it seems that covered stent placement for a period of 6-8 weeks is safe and effective for benign esophageal ruptures and anastomostic leaks to heal. As efficacy between different stent types is not significantly different, stent choice should depend on expected risk of stent migration (SEPS and FSEMS) and to a minor degree on expected risk of tissue in- or overgrowth (PSEMS).