Meta-analysis of the safety and efficacy of metal stents for benign tracheal stenosis

M. Fan^a (Dr), S. Li^a (Prof), Z. Su*^a (Dr)

^a The First Affiliated Hospital of Guangzhou Medical University, Department of Pulmonary and Critical Care Medicine, Guangzhou, CHINA

* py1011xiaoquan@163.com

Abstract

Objective: Even though the use of self-expandable metallic stents (SEMS) in benign airway diseases has been warned by the FDA due to the risk of stent-related complications and difficulties of their removal, accumulating studies have yielded inconsistent or conflicting findings. To shed light on these contradictory results and to more precisely evaluate the relationship between self-expandable metallic stents and benign tracheal stenosis (BTS), we performed a meta-analysis of published studies.

Data sources: PubMed, the Cochrane Library, Web of Science, Embase and ClinicalTrials.gov from January 2000 to April 2022.

Review methods: Data on related trials were obtained by doing a literature search in PubMed, Web of Science and Cochrane Library. Random-effect and fixed-effect models were used to calculate the efficacy and incidence of complication of SEMS placement.Results: A total of 575 participants received 700 SEMS over this period. The main causes of benign airway stenosis included tracheotomy (32.8%), anastomotic stenosis after transplantation or lobectomy (31.3%), tracheal intubation (18.1%), and airway stenosis caused by other benign diseases (17.8%). The study showed that the effective rate of metal stent in the treatment of benign airway stenosis was 73.8%, the average placement time was 9.2 ±13.4 months, while the success rate of stent removal was 92.5%. The incidence of complications after stent implantation was 48.6%, including granulation tissue hyperplasia (30%), stent displacement (16.5%), mucus occlusion (10.9%), and airway restenosis (16%). Stent-related mortality was not occurred.Conclusions: SEMS might serve as an effective treatment for benign airway stenosis with bronchoscopic treatable complications and rare potential life-threatening reactions, particularly in the short term use for maintaining airway patency under the intensive observation. Further multicenter trials are needed to subsequently verify the efficacy and safety of SEMS in the treatment of benign airway stenosis.Keywords: Bronchoscopy; Self-expandable metallic stent; Tracheal stenosis; Safety; Meta-analysis

Disclosure of funding source(s): none