Bronchial stenting in advanced esophageal carcinoma: a systematic review and meta-analysis

SESSION TITLE: Procedures Posters 4 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Tracheobronchial stenting, either as a standalone procedure or in combination with esophageal stenting, is commonly used for the palliative treatment of obstructive or fistulous lesions of the airway resulting from esophageal cancer. However, there is insufficient evidence regarding the efficacy and safety of airway stenting for lesions near the carina in patients with esophageal cancer. To address this gap, a systematic review and meta-analysis was conducted to evaluate the technical feasibility, outcomes, and potential complications of preplanned dual stenting for these patients. METHODS: We searched electronic databases like PubMed, PubMed Central (PMC), Scopus, and Embase for relevant articles with keywords “tracheobronchial stenting” and “esophageal carcinoma” until February 15th, 2023. Two reviewers performed screening independently, and data was extracted from selected studies. We performed a statistical analysis on Raveman 5 software. The odds ratio was used for outcome estimation with a 95% confidence interval. RESULTS: Our analysis included six uncontrolled observational studies with a total of 333 patients. The mean age of participants was 56.6 ± 3.1 years. Pooled analysis of studies revealed the median survival after airway stenting to be 106.89 days (95% CI=70.94 – 142.84, P≤0.001, I2=92.17%) in patients with infiltrating esophageal carcinoma. Our analysis demonstrated a median survival of 89.06 days (95% CI=78.23 – 99.90, P=0.414, I2= 0%). The most commonly reported complications of bronchial stenting were mucus plugging, infection, obstruction, and formation of granulation tissue with a prevalence of 34.3% (95% CI=7.7%-68.1%,P≤0.001, I2=91.36%), 32% (95% CI=14.2%-53.7%, P=0.004, I2=77.73%), 18.6% (95% CI=2.8% - 43.9%, P≤0.001, I2=90.91) and 13.1% (95% CI=5.4%-23.6%, P=0.044, I2= 62.87%) respectively. It is important to note that in 3 studies, dual stenting (both tracheobronchial and esophageal stenting) was performed in 38%, 11% and 100% of the patient population respectively. CONCLUSIONS: Bronchial stenting is a viable option for palliative treatment in patients with infiltrating esophageal carcinoma who have obstructive or fistulous airway lesions. The median survival following airway stenting in patients with infiltrating esophageal cancer was 106.89 days, a statistically significant finding. Mucus plugging, infection, blockage, and granulation tissue formation were the most reported consequences after bronchial stenting, with a prevalence ranging from 13.1% to 34.3%. These findings highlight the importance of carefully considering and managing problems while doing bronchial stenting in esophageal cancer patients. CLINICAL IMPLICATIONS: Those ineligible for other treatments and requiring rapid relief from airway blockage due to esophageal cancer may be candidates for this procedure. 2. The high incidence of adverse events associated with bronchial stenting, such as mucus plugging, infection, obstruction, and granulation tissue formation, suggests that its use in patients with esophageal cancer should be carefully considered. As a means of reducing morbidity and mortality, healthcare providers must be able to address such complications swiftly. 3. In addition, the findings of this study demonstrate the necessity for additional rigorous and controlled trials to examine the safety and efficacy of bronchial stenting in patients with esophageal cancer. Further research may shed light on the risk factors linked with problems, the best timing for stent insertion, and other aspects that may enhance patient outcomes. DISCLOSURES: No relevant relationships by Usman Akbar No relevant relationships by Muhammad Ghallab No relevant relationships by Muhammad Haseeb-ul-Rasool No relevant relationships by Asma Hosna No relevant relationships by Saad Khalid No relevant relationships by Muhammad Aslam Khan No disclosure on file for Jawad Khan I presently own stock. relationship with AMGEN, inc Please note: 3/2018-present Added 04/10/2023 by Ricardo Lopez, source=Web Response, value=Nothing received. No relevant relationships by Eugene Shostak No relevant relationships by Theo Trandafirescu No relevant relationships by Zaryab Umar