Is self-expandable metallic stents superior to transanal decompression tubes for the treatment of malignant large-bowel obstruction: a meta-analysis

BACKGROUND Preoperative intestinal decompression, such as self-expandable metallic stents (SEMS) and transanal decompression tubes (TDT), has been widely used for patients with malignant large-bowel obstruction (MLBO). The aim of this study is to evaluate the clinical outcomes of SEMS for MLBO as a bridge to surgery compared to TDT. METHODS We searched three databases, including PubMed, Embase, and Web of Science from inception until June 12, 2019. Risk ratio (RR) or weight mean difference (WMD) with 95% CIs was used to calculate the data extracted from included studies. RESULTS Five studies with 226 participants were included in this review. SEMS insertion showed significantly higher clinical success rate (RR =1.30, 95% CI: 1.06, 1.60; P=0.012) and technical success rate (RR =1.33, 95% CI: 1.07, 1.65; P=0.011), as well as higher rates of solid food intake (RR =27.15, 95% CI: 8.73, 84.45; P<0.001) and temporal discharge (RR =64.47, 95% CI: 9.10, 456.57; P<0.001), as compared with TDT insertion. Moreover, SEMS insertion significantly reduced the blood loss (WMD =-69.73 mL, 95% CI: -81.61, -57.85; P<0.001), and prolonged the operative time (WMD =93.49 minutes, 95% CI: 14.24, 172.75; P=0.021) in the treatment of MLBO. Duration of hospital stay, complication rate and mortality rate were comparable between the two treatments. DISCUSSION Preoperative SEMS insertion offered better effects for MLBO, including higher success rate, and higher rates of solid food intake and temporary discharge, compared with TDT.