Endoscopic suturing of esophageal fully covered self-expanding metal stents reduces rates of stent migration

• Published in: Gastrointestinal endoscopy Vol. 86; no. 6; pp. 1015 - 1021
• Main Authors: Bick, Benjamin L., MD, Imperiale, Thomas F., MD, Johnson, Cynthia S., MA, DeWitt, John M., MD, FASGE, FACG, AGAF
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2017
• Subjects: Adult; Aged; Endoscopy, Gastrointestinal; Esophageal Stenosis - therapy; Female; Foreign-Body Migration - prevention & control; Gastroenterology and Hepatology; Humans; Male; Middle Aged; Prosthesis Failure - etiology; Prosthesis Implantation - methods; Retrospective Studies; Self Expandable Metallic Stents - adverse effects; Suture Techniques; SERF; FC-SEMS; OR; GEE; self-expanding metal stent-associated esophago-respiratory fistula; generalized estimating equation; odds ratio; S-FCSEMS; clinically significant stent migration; partially covered self-expanding metal stent; CSSM; endoscopically sutured fully covered self-expanding metal stent; fully covered self-expanding metal stent; PC-SEMS; ASM; any stent migration; SEMS; self-expanding metal stent
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2017.03.1545

Background and Aims Endoscopic suturing of fully covered self-expanding metal stents (FC-SEMSs) may prevent migration. The aim of this study was to compare rates of migration between sutured FC-SEMSs (S-FCSEMSs), unsecured FC-SEMSs, and partially covered SEMSs (PC-SEMSs) placed for benign esophageal leaks and strictures. Methods In a retrospective, single-center, cohort study, rates of migration for S-FCSEMSs, FC-SEMSs, and PC-SEMSs were assessed in patients with at least 1 month of follow-up or experiencing clinically significant stent migration (CSSM) any time after placement. CSSM was defined as proximal or distal displacement of the stent by ≥2 cm or passage into the stomach plus the recurrence of pre-SEMS symptoms or signs. A multivariable analysis was done to identify additional risk factors for stent migration. Results A total of 184 SEMSs were placed in 101 patients, including 32 S-FCSEMSs in 25 patients, 114 FC-SEMSs in 59 patients, and 38 PC-SEMSs in 30 patients. CSSM occurred with 56 of 184 stents (30.4%) in 36 of 101 patients (35.6%), including 3 of 32 (9.4%) S-FCSEMSs, 45 of 114 (39.5%) FC-SEMSs, and 8 of 38 (21.1%) PC-SEMSs ( P  = .005). Migration was less likely for S-FCSEMSs than for FC-SEMSs (9.4% vs 39.5%; P  = .01) but not between S-FCSEMSs and PC-SEMSs (9.4% vs 21.1%; P  = .07) or between FC-SEMSs and PC-SEMSs (39.5% vs 21.1%; P  = .38). Previous stent migration (odds ratio [OR], 3.93; 95% confidence interval [CI], 1.88-8.19; P  = .01) and previous esophageal surgery (OR, 0.33; 95% CI, 0.16-0.67; P  = .002) were associated with increased and decreased risk of CSSM, respectively. Conclusions Endoscopic suturing of FC-SEMSs for benign esophageal disease reduces CSSM compared with unsecured FC-SEMSs but not PC-SEMSs. Patients with previous stent migration may benefit from prophylactic suturing of FC-SEMSs.