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Erschienen in: Surgical Endoscopy 9/2017

07.12.2016

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

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

Erschienen in: Surgical Endoscopy | Ausgabe 9/2017

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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.
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Metadaten
Titel
Endoscopic suture fixation is associated with reduced migration of esophageal fully covered self-expandable metal stents (FCSEMS)
verfasst von
Andrew Wright
Andrew Chang
Aarti Oza Bedi
Erik-Jan Wamsteker
Grace Elta
Richard S. Kwon
Phillip Carrott
B. Joseph Elmunzer
Ryan Law
Publikationsdatum
07.12.2016
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 9/2017
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5374-z

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