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 Pub/Vied, 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.