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

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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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Author contributions

AW was involved in data collection, statistical analysis, and drafting of the manuscript. AC, AOB, E-JW, GE, RK, and PC were involved in critical review and final manuscript approval. BJE was involved in critical review, statistical analysis, and final manuscript approval. RL was involved in article conception, drafting of the manuscript, and final manuscript approval.

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Authors and Affiliations

  1. Division of Gastroenterology, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Dr., SPC 5362, Ann Arbor, MI, 48109-5362, USA

    Andrew Wright, Aarti Oza Bedi, Erik-Jan Wamsteker, Grace Elta, Richard S. Kwon & Ryan Law

  2. Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA

    Andrew Chang & Phillip Carrott

  3. Digestive Disease Center, Medical University of South Carolina, Charleston, SC, USA

    B. Joseph Elmunzer

Authors
  1. Andrew Wright
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  2. Andrew Chang
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  3. Aarti Oza Bedi
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  4. Erik-Jan Wamsteker
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  5. Grace Elta
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  6. Richard S. Kwon
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  7. Phillip Carrott
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  8. B. Joseph Elmunzer
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  9. Ryan Law
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Corresponding author

Correspondence to Ryan Law.

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Disclosures

Authors Andrew Wright, Andrew Chang, Aarti Oza Bedi, Erik-Jan Wamsteker, Grace Elta, Richard S. Kwon, Phillip Carrott, B. Joseph Elmunzer, and Ryan Law declare that they have no conflicts of interests or financial disclosure ties to disclose.

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Wright, A., Chang, A., Bedi, A.O. et al. Endoscopic suture fixation is associated with reduced migration of esophageal fully covered self-expandable metal stents (FCSEMS). Surg Endosc 31, 3489–3494 (2017). https://doi.org/10.1007/s00464-016-5374-z

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  • DOI: https://doi.org/10.1007/s00464-016-5374-z

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