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Surgical Endoscopy
Published in: Surgical Endoscopy 1/2012

01-01-2012

The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study

Authors: Geoffroy Vanbiervliet, Jérôme Filippi, Babou Soilihi Karimdjee, Nicolas Venissac, Antonio Iannelli, Amine Rahili, Emmanuel Benizri, Daniel Pop, Pascal Staccini, Albert Tran, Stéphane Schneider, Jérôme Mouroux, Jean Gugenheim, Daniel Benchimol, Xavier Hébuterne

Published in: Surgical Endoscopy | Issue 1/2012

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Abstract

Background

Migration is the most common complication of the fully covered metallic self-expanding esophageal stent (SEMS). This study aimed to determine the potential preventive effect of proximal fixation on the mucosa by clips for patients treated with fully covered SEMS.

Methods

In this study, 44 patients (25 males, 57%) were treated with fully covered SEMS including 22 patients with esophageal stricture (4 malignant obstructions, 6 anastomotic strictures, and 12 peptic strictures) and 22 patients with fistulas or perforations (10 anastomotic leaks, 4 perforations, and 8 postbariatric surgery fistulas). The Hanarostent (n = 25), Bonastent (n = 5), Niti-S (n = 12), and HV-stent (n = 2) with diameters of 18 to 22 mm and lengths of 80 to 170 mm were used. Two to four clips (mean, 2.35 ± 0.75 clips) were used consecutively in 23 patients to fix the upper flared end of the stent with the esophageal mucosal layer. Stent migration and its consequences were collected in the follow-up assessment with statistical analysis to compare the patients with and without clip placement.

Results

No complication with clip placement was observed, and the retrieval of the stent was not unsettled by the persistence of at least one clip (12 cases). Stent migration was noted in 15 patients (34%) but in only in 3 of the 23 patients with clips (13%). The number of patients treated to prevent one stent migration was 2.23. The predictive positive value of nonmigration after placement of the clip was 87%. In the multivariate analysis, the fixation with clips was the unique independent factor for the prevention of stent migration (odds ratio, 2.3; 95% confidence interval, 0.10–0.01; p = 0.03).

Conclusions

Anchoring of the upper flare of the fully covered SEMS with the endoscopic clip is feasible and significantly reduces stent migration.
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Metadata
Title
The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study
Authors
Geoffroy Vanbiervliet
Jérôme Filippi
Babou Soilihi Karimdjee
Nicolas Venissac
Antonio Iannelli
Amine Rahili
Emmanuel Benizri
Daniel Pop
Pascal Staccini
Albert Tran
Stéphane Schneider
Jérôme Mouroux
Jean Gugenheim
Daniel Benchimol
Xavier Hébuterne
Publication date
01-01-2012
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 1/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-011-1827-6

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