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Endoscopic vacuum therapy versus endoscopic stenting for upper gastrointestinal transmural defects: Systematic review and meta‐analysis
Author(s) -
do Monte Junior Epifanio Silvino,
de Moura Diogo Turiani Hourneaux,
Ribeiro Igor Braga,
Hathorn Kelly Elizabeth,
Farias Galileu Ferreira Ayala,
Turiani Carolina Vaz,
Medeiros Flaubert Sena,
Bernardo Wanderley Marques,
de Moura Eduardo Guimarães Hourneaux
Publication year - 2021
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13813
Subject(s) - medicine , adverse effect , meta analysis , cochrane library , systematic review , medline , surgery , political science , law
Background Upper gastrointestinal fistulas, leaks, and perforations represent a high cost burden to health systems worldwide, with high morbidity and mortality rates for affected patients. Management of these transmural defects remains therapeutically challenging. Objectives The aim of this study is to perform a systematic review and meta‐analysis to investigate the efficacy and safety of self‐expanding metal stents (SEMS) versus endoscopic vacuum therapy (EVT) for treatment of upper gastrointestinal transmural defects. Methods Searches were performed on MEDLINE, EMBASE, Central Cochrane, Latin American and Caribbean Health (LILACS), and gray literature, as well as a manual search to identify studies comparing SEMS versus EVT to treat upper gastrointestinal transmural defects. Evaluated outcomes were: rates of successful closure, mortality, length of hospital stay, duration of treatment, and adverse events. Results Five studies with a total of 274 patients were included. There was a 21% increase in successful fistula closure attributed to EVT compared with the SEMS group (RD 0.21, CI 0.10–0.32; P = 0.0003). EVT demonstrated a 12% reduction in mortality compared to stenting (RD 0.12, CI 0.03–0.21; P = 0.006) and an average reduction of 14.22 days in duration of treatment (CI 8.38–20.07; P < 0.00001). There was a 24% reduction in adverse events (RD 0.24, CI 0.13–0.35; P = 0.0001. There were no statistical differences between the studied therapies regarding the length of hospital stay. Conclusion Endoscopic vacuum therapy proves to be superior in successful defect closure, mortality, adverse events and duration of treatment.