Top

Published in:

01-09-2017

Endoscopic suture fixation is associated with reduced migration of esophageal fully covered self-expandable metal stents (FCSEMS)

Authors: Andrew Wright, Andrew Chang, Aarti Oza Bedi, Erik-Jan Wamsteker, Grace Elta, Richard S. Kwon, Phillip Carrott, B. Joseph Elmunzer, Ryan Law

Published in: Surgical Endoscopy | Issue 9/2017

Abstract

Background

Esophageal fully covered self-expandable metal stents (FCSEMS) are indicated for the management of benign and malignant conditions of the esophagus including perforations, leaks, and strictures. FCSEMS are resistant to tissue ingrowth and are removable; however, stent migration occurs in 30–55% of cases. Endoscopic suture fixation of FCSEMS has been utilized to decrease the risk of stent migration though data supporting this practice remain limited. The primary aim of this study was to compare clinical outcomes and migration rate of patients who underwent placement of esophageal FCSEMS with and without endoscopic suture fixation.

Methods

Our single-center, retrospective, cohort study includes patients who underwent esophageal FCSEMS placement with and without endoscopic suture fixation between January 1, 2012, and November 11, 2015. Baseline patient characteristics, procedural details, and clinical outcomes were abstracted. Logistic regression was performed to identify clinical and technical factors associated with outcomes and stent migration.

Results

A total of 51 patients underwent 62 FCSEMS placements, including 21 procedures with endoscopic suture fixation and 41 without. Suture fixation was associated with reduced risk of stent migration (OR 0.13, 95% CI 0.03–0.47). Prior stent migration was associated with significantly higher risk of subsequent migration (OR 6.4, 95% CI 1.6–26.0). Stent migration was associated with lower likelihood of clinical success (OR 0.21, 95% CI 0.06–0.69). There was a trend toward higher clinical success among patients undergoing suture fixation (85.7 vs. 60.9%, p = 0.07).

Conclusions

Endoscopic suture fixation of FCSEMS was associated with a reduced stent migration rate. Appropriate patient selection for suture fixation of FCSEMS may lead to reduced migration in high-risk patients.

Fuji LL, Bonin EA, Baron TH, Gostout CJ, Wong Kee Song LM (2013) Utility of an endoscopic suturing system for prevention of covered luminal stent migration in the upper GI tract. Gastrointest Endosc 78:787–793CrossRef

Sharaiha RZ, Kumta NA, Doukides TP, Eguia V, Gonda TA, Widmer JL, Turner BG, Poneros JM, Gaidhane M, Kahaleh M, Sethi A (2015) Esophageal stenting with sutures: time to redefine our standards? J Clin Gastroenterol 49:e57–e60CrossRefPubMed

Bakken JC, Wong Kee Song LM, de Groen PC, Baron TH (2010) Use of a fully covered self-expandable metal stent for the treatment of benign esophageal diseases. Gastrointest Endosc 72:712–720CrossRefPubMed

Wagh MS, Forsmark CE, Chauhan S, Draganov PV (2012) Efficacy and safety of a fully covered esophageal stent: a prospective study. Gastrointest Endosc 75:678–682CrossRefPubMed

Vanbiervliet G, Filippi J, Karimdjee BS, Venissac N, Iannelli A, Rahili A, Benizri E, Pop D, Staccini P, Tran A, Schneider S, Mouroux J, Gugenheim J, Benchimol D, Hébuterne X (2012) The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study. Surg Endosc 26:53–59CrossRefPubMed

Mudumbi S, Velazquez-Aviña J, Neumann H, Kyanam Kabir Baig KR, Mönkemüller K (2014) Anchoring of self-expanding metal stents using the over-the-scope clip, and a technique for subsequent removal. Endoscopy 46:1106–1109CrossRefPubMed

Kantsevoy SV, Bitner M (2012) Esophageal stent fixation with endoscopic suturing device (with video). Gastrointest Endosc 76:1251–1255CrossRefPubMed

Hanauer DA, Mei Q, Law J, Khanna R, Zheng K (2015) Supporting information retrieval from electronic health records: a report of University of Michigan’s nine-year experience in developing and using the Electronic Medical Record Search Engine (EMERSE). J Biomed Inform 55:290–300CrossRefPubMedPubMedCentral

Shin EJ, Ko CW, Magno P, Giday SA, Clarke JO, Buscaglia JM, Sedrakyan G, Jagannath SB, Kalloo AN, Kantsevoy SV (2007) Comparative study of endoscopic clips: duration of attachment at the site of clip application. Gastrointest Endosc 66:757–761CrossRefPubMed

10.

Irani S, Baron TH, Gluck M, Gan I, Ross AS, Kozarek RA (2014) Preventing migration of fully covered esophageal stents with an over-the-scope clip device (with videos). Gastrointest Endosc 79:844–851CrossRefPubMed

Title: Endoscopic suture fixation is associated with reduced migration of esophageal fully covered self-expandable metal stents (FCSEMS)
Authors: Andrew Wright
Andrew Chang
Aarti Oza Bedi
Erik-Jan Wamsteker
Grace Elta
Richard S. Kwon
Phillip Carrott
B. Joseph Elmunzer
Ryan Law
Publication date: 01-09-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 9/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5374-z

At a glance: The STEP trials

Springer Medicine

Endoscopic suture fixation is associated with reduced migration of esophageal fully covered self-expandable metal stents (FCSEMS)

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2017

Learning curve and clinical outcome of gastric endoscopic submucosal dissection performed by trainee operators

Infrahepatic inferior vena cava clamping with Pringle maneuvers for laparoscopic extracapsular enucleation of giant liver hemangiomas

Respiratory dynamics and dead space to tidal volume ratio of volume-controlled versus pressure-controlled ventilation during prolonged gynecological laparoscopic surgery

Laparoscopic-assisted versus open total gastrectomy for Siewert type II and III esophagogastric junction carcinoma: a propensity score-matched case-control study

Superiority of laparoscopic proximal gastrectomy with hand-sewn esophagogastrostomy over total gastrectomy in improving postoperative body weight loss and quality of life

A novel procedure for introducing large sheet-type surgical material with a self-expanding origami structure using a slim trocar (chevron pleats procedure)