hemostasis in uncontrolled esophageal variceal bleeding by self-expanding metal stents: a systematic review

aim : the aim of this systematic review was to evaluate the current reported efficacy and the mortality rate of sems treatment in uncontrolled bleeding patients.   background : esophageal variceal bleeding (evb) represents a life threatening pathology. despite the adequate pharmacologic and endoscopic treatment, continuous or recurrent bleeding, named as uncontrolled bleeding, occurs in 10-20% of cases. a new removable, covered, and self-expanding metal stent (sems) was proposed to control the variceal bleeding. materials and methods : the study was conducted according to the prisma statement. studies were identified by searching medline (1989-present) and scopus (1989-present) databases. the last search was run on 01 july 2015. results : nine studies (period range=2002-2015) met the inclusion criteria and were included in quantitative analysis. high rate of sems efficacy in controling acute bleeding was observed, with a reported percentage ranging from 77.7 to 100%. in 10% to 20% of patients, re-bleeding occurred with sems in situ. stent deployment was successful in 77.8% to 100% of patients while 11 to 36.5% of patients experienced stent migration. conclusion : sems could be effective and safe in control evb and can be proposed as a reliable option to ballon tamponed for patient stabilization and as a bridging to other therapeutic approach.