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Title: Endoscopic vacuum therapy versus endoscopic stenting for upper gastrointestinal transmural defects: Systematic review and meta-analysis
Authors: MONTE JUNIOR, Epifanio Silvino doMOURA, Diogo Turiani Hourneaux deRIBEIRO, Igor BragaHATHORN, Kelly ElizabethFARIAS, Galileu Ferreira AyalaTURIANI, Carolina VazMEDEIROS, Flaubert SenaBERNARDO, Wanderley MarquesMOURA, Eduardo Guimaraes Hourneaux de
Citation: DIGESTIVE ENDOSCOPY, v.33, n.6, p.892-902, 2021
Abstract: Background: Upper gastrointestinal fistulas, leaks, and perforations represent a high cost burden to health systems worldwide, with high morbidity and mortality rates for affected patients. Management of these transmural defects remains therapeutically challenging. Objectives: The aim of this study is to perform a systematic review and meta-analysis to investigate the efficacy and safety of self-expanding metal stents (SEMS) versus endoscopic vacuum therapy (EVT) for treatment of upper gastrointestinal transmural defects. Methods: Searches were performed on MEDLINE, EMBASE, Central Cochrane, Latin American and Caribbean Health (LILACS), and gray literature, as well as a manual search to identify studies comparing SEMS versus EVT to treat upper gastrointestinal transmural defects. Evaluated outcomes were: rates of successful closure, mortality, length of hospital stay, duration of treatment, and adverse events. Results: Five studies with a total of 274 patients were included. There was a 21% increase in successful fistula closure attributed to EVT compared with the SEMS group (RD 0.21, CI 0.10-0.32; P = 0.0003). EVT demonstrated a 12% reduction in mortality compared to stenting (RD 0.12, CI 0.03-0.21; P = 0.006) and an average reduction of 14.22 days in duration of treatment (CI 8.38-20.07; P < 0.00001). There was a 24% reduction in adverse events (RD 0.24, CI 0.13-0.35; P = 0.0001. There were no statistical differences between the studied therapies regarding the length of hospital stay. Conclusion: Endoscopic vacuum therapy proves to be superior in successful defect closure, mortality, adverse events and duration of treatment.
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Artigos e Materiais de Revistas Científicas - HC/ICHC
Instituto Central - HC/ICHC

Artigos e Materiais de Revistas Científicas - LIM/35
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo

Artigos e Materiais de Revistas Científicas - LIM/47
LIM/47 - Laboratório de Hepatologia por Vírus

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