A systematic review and meta-analysis of factors associated with esophageal stent migration and a comparison of antimigration techniques

Abstract

Background

Esophageal stents are effective in managing various pathologies. However, they are limited by their most common complication: migration. This study aimed to present the largest comprehensive review of the risk factors associated with stent migration and the interventions leveraged to prevent stent migration.

Methods

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria were primary data sources (no systematic reviews), ≥18 years of age, esophageal stent placement, and reported indication for intervention, site of placement, and migration rate. A total of 162 studies met the inclusion criteria. Proportions experiencing migration were pooled using a random-effects model with a DerSimonian-Laird estimator to account for potential heterogeneity, and forest plots were used to visualize the treatment effects across studies.

Results

A total of 14,092 patients were included in the analysis. The mean migration rate across all studies and stent types was 17.2%, and the mean reintervention rate was 83.2%. Cancerous indications, benign strictures, history of esophageal surgery, stent diameter of <20 mm, plastic stents, and fully covered stents were associated with significantly higher migration rates. There was a trend toward stents using antimigration technology having lower migration rates (effect size [ES] = 0.15; 95% CI, 0.10–0.20) than those that did not (ES = 0.33; 95% CI, 0.18–0.48). However, this difference was not significant. There were no statistically significant differences among the stent fixation strategies (clips, sutures, wire hooks, and Shim technique).

Conclusion

Several risk factors are associated with stent migration. However, no currently available solutions can significantly reduce stent migration. Further optimization of these devices or the creation of new technology to prevent migration is required.