Comparing Endoscopic Suture vs Clip vs No Intervention in Esophageal Stent Migration: A Network Meta-analysis

Background and aims Stent migration is a consequential complication associated with esophageal stent placement. We aimed to compare endoscopic suturing vs clips vs no intervention to determine optimal strategy. Methods Literature search was performed using MEDLINE, Embase, Cochrane, Web of Science, and Global Index Medicus databases. Direct head-to-head comparator analysis and network meta-analysis of all available groups were performed using the random-effects model. A p-value < 0.05 was considered statistically significant. Results 10 studies with 1019 participants were included in the final analysis. The direct meta-analysis revealed comparable stent migration rates between endoscopic suturing and clips, odds ratio (OR) of 1.07 (95% CI: 0.07-14.8, p = 0.96), signifying no significant difference in their efficacy. When compared to the no intervention group, endoscopic suturing demonstrated a lower stent migration rate, with an OR of 0.33 (95% CI: 0.17-0.62, p < 0.001). Conversely, endoscopic clips did not exhibit a statistically significant advantage over the no intervention group, displaying an OR of 0.29 (95% CI: 0.06-1.48, p = 0.14). Results were consistent on the network meta-analysis, maintaining consistency. The rankings of interventions, as reflected by the P-scores, underscored the superior effectiveness of endoscopic suturing with a score of 0.78, followed closely by endoscopic clips at 0.70, while the no intervention approach lagged behind with a score of only 0.03. Conclusion Our findings indicate stent fixation with sutures significantly prevents stent migration, with no clear advantage of one modality over another. However, it is essential to acknowledge that the feasibility of implementing endoscopic suture fixation in every case is constrained by cost, time, and technical expertise.