Comparing Gastrostomy and Self-Expandable Metallic Stent for Treatment of Dysphagia Caused by Cancer: A Systematic Review, Meta-analysis and Meta-regression

Masihallah Shakeri; Poorya  Aryanpoor; Fatemeh  Eftekharian; Naser  Hatami; Navid  Kalani

doi:10.18502/jimc.v9i2.21170

Masihallah Shakeri Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
Poorya Aryanpoor Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
Fatemeh Eftekharian Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
Naser Hatami Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
Navid Kalani Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran

DOI: https://doi.org/10.18502/jimc.v9i2.21170

Keywords: Aspiration, Deglutition disorders, Gastrostomy, Incidence, Lung neoplasms, Pneumonia, Publication bias, Self expandable metallic stents, Serum albumin

Abstract

Background: Dysphagia is an important complication that occurs in some patients with cancers and malignancies, such as esophageal and lung cancer, and can influence patients’ weight and serum albumin levels. The placement of Self-Expanding Metallic Stents (SEMS) and gastrostomy are common therapies for cancer-related dysphagia. The aim of the present study was to compare SEMS and gastrostomy in terms of changes in serum albumin level, changes in weight, three-, six-, nine- and twelve-month Overall Survival (OS) of patients and also the need for additional reintervention and incidence of aspiration pneumonia after the first procedure.

Methods: This was a systematic review and meta-analysis study based on the PRISMA guidelines. Scopus, Web of Sciences, and PubMed databases were searched for studies, reporting out comes of interest mentioned above and compared both groups. The Egger bias test and funnel plot were used to detect and depict publication bias.

Results: Five studies were eligible for inclusion in this study. SEMS group had a higher decrease in serum albumin level (SMD =-0.53, 95% CI: -0.92 to-0.15 mg/dl; p=0.006) and weight (SMD=-0.08, 95% CI: -0.38 to 0.21; p=0.57) and need for additional reintervention (OR=5.23, 95%CI: 1.27 to 21.48; p=0.02) compared to the gastrostomy group after the intervention, patients that underwent the SEMS placement had lower twelve-month OS (OR=0.24, 95%CI: 0.14 to 0.41; p<0.001).

Conclusion: Patients of gastrostomy group have lower decrease in serum albumin level, need for additional intervention and better twelve-month OS.