Efficacy of endoscopic over-the-scope clip fixation for preventing migration of self-expandable metal stents: a systematic review and meta-analysis

Success rates of fixation techniques on prevention of esophageal stent migration: a systematic review and meta-analysis

“…However, this outcome had significant heterogeneity, which was a reflection of the various definitions among studies (eg, dysphagia relief for malignant strictures, stricture or leak/fistula resolution for benign conditions) and limits the safe interpretation of this result. Previous meta-analyses in this field have attempted to establish stent fixation as a reasonable approach and supported the beneficial role of suturing [12] and OTS clips [13], though with absence of strong evidence owing to their design and type of included studies. Law et al [12] included 12 studies, albeit with only 212 patients, and calculated the pooled rate of esophageal stent migration after endoscopic suturing, but did not compare this rate with the rate for nonanchored esophageal stents.…”

“…Conversely, in a direct comparison, Park et al 27 indicated similar migration rates for sutured and nonsutured esophageal stents, with an OR of 0.99 (95 %CI 0.55–1.78), thus implying the need to reassess the benefit of esophageal stent fixation. In a recent study, Jena et al 13 , assessed the anti-migration role of OTS clips on SEMSs along the gastrointestinal tract, and calculated the pooled rates of stent migration. With regard to esophageal stents, the SEMS pooled migration rate was 8 % compared with 14.9 % in our study, probably as a result of the higher number cohort studies.…”

“…[1,11] To date, two meta-analyses assess the migration rates of ES after fixation with suturing and of over-the-scope-clips (OTSC) by assessing cumulative pooled rates of cohort and case-series. [12,13] The reduced pooled rates of stent migration are promising for both fixation techniques, however evaluation in comparison to non-fixated stenting was not performed. Emerging comparative studies evaluating different fixation techniques have been published, thus allowing the accumulation of their results to clarify the plain value of ES fixation.…”

“…Furthermore, the number of required stitches has not been established, varying from one to more than three at the endoscopist's discretion. Regarding OTS clipping, a dedicated device has been developed to anchor stents, yielding a successful stent capture in 98 % (95 %CI 80-100) of cases, with no difference compared with traditional OTS clips [13]. In the esophagus, where the perpendicular positioning of the cap to capture both the stent and esophageal tissue is difficult, the design of this dedicated OTS clip facilitates successful deployment and transmural entrapment.…”

“…To date, two meta-analyses have assessed the migration rates of esophageal stents after fixation with suturing and over-the-scope (OTS) clips by assessing cumulative pooled rates of cohort and case series [12,13]. The reduced pooled rates of stent migration are promising for both fixation techniques; however, evaluation comparing fixation and nonfixa-tion was not performed.…”