Esophageal Stenting With Sutures

Sharaiha, Reem Z.; Kumta, Nikhil A.; Doukides, Theodore; Eguia, Vasco; Gonda, Tamas A.; Widmer, Jessica L.; Turner, Brian G.; Poneros, John M.; Gaidhane, Monica; Kahaleh, Michel; Sethi, Amrita

doi:10.1097/mcg.0000000000000198

Cited by 27 publications

(21 citation statements)

References 31 publications

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“…However, the use of cSEMS has demonstrated high rates of migration that may occur early in the period after stent placement, which may ultimately compromise long-term clinical success. Endoscopic suturing of cSEMS to tissue has been a recent advance that has mitigated this issue of migration[ 8 ], but this procedure is expensive and can be technically challenging[ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Lumen-apposing metal stents for benign gastrointestinal tract strictures: An international multicenter experience

Santos-Fernández

Paiji

Shakhatreh

et al. 2017

WJGE

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AIMTo investigate technical feasibility, outcomes and adverse events of the lumen-apposing metal stent (LAMS) for benign gastrointestinal (GI) tract strictures.METHODSBetween July 2015 and January 2017, patients undergoing treatment by LAMS for benign GI strictures at three tertiary referral centers were included in this study. Primary outcomes included technical success, short-term clinical success, long-term clinical success, and adverse events. Short-term clinical success was defined as symptom resolution at 30 d after stent placement. Long-term clinical success was defined by symptom resolution at 60 d in patients who continued to have indwelling stent, or continued symptom resolution at 30 d after elective stent removal.RESULTSA total of 21 patients (mean age 62.6 years, 47.6% males) underwent placement of LAMS for benign GI strictures. A 15 mm × 10 mm LAMS was placed in 16 patients, a 10 mm × 10 mm LAMS was placed in 2 patients, and a 16 mm × 30 mm LAMS was placed in 3 patients. Technical success was obtained in all cases. Short-term clinical success was achieved in 19 out of 21 cases (90.5%), and long-term clinical success was achieved in 12 out of 18 (66.7%). Mean (range) stent indwell time was 107.2 (28-370) d. After a mean (range) dwell time of 104.3 (28-306) d, 9 LAMSs were removed due to the following complications: ulceration at stent site (n = 1), angulation (n = 2), migration (n = 4) and stricture overgrowth (n = 2). Migration occurred in 4 cases (19.0%), and it was associated with stricture resolution in one case. Median (range) follow-up period was 119 (31-422) d.CONCLUSIONUtilization of LAMS for benign strictures has shown to be technically feasible and safe, but adverse events highlight the need for further study of its indications.

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Section: Introductionmentioning

confidence: 99%

Lumen-apposing metal stents for benign gastrointestinal tract strictures: An international multicenter experience

Santos-Fernández

Paiji

Shakhatreh

et al. 2017

WJGE

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“…In a recently published cohort of patients with prior FCSEMS migration, Irani et al [10] showed an 85% reduction in stent migration when an OTS clipping device (OTSC; Ovesco, Tubingen, Germany) was used to anchor the FCSEMS. As mentioned previously, published data suggest a reduced rate of stent migration among patients that underwent suture fixation of esophageal FCSEMS compared to non-anchored controls (11.7 vs. 55%) [2]. OTS clipping devices and endoscopic suturing both appear to be promising techniques for reducing FCSEMS migration, but come with an increase in procedural costs (~$300–$800) which must be considered.…”

Section: Discussionmentioning

confidence: 96%

“…Esophageal FCSEMS (1) provide resistance to tissue ingrowth in malignant or benign strictures, (2) provide a luminal seal over perforations, leaks, and fistulae, and (3) are generally retrievable without difficulty. Historically, the major limitation of FCSEMS placement has been stent migration, occurring in up to 30–55% of cases [2–4]. …”

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confidence: 99%

“…More recently, endoscopic suture anchoring of FCSEMS has been utilized to decrease the risk of stent migration [1, 2, 7]. One small retrospective study reported a reduced rate of stent migration among patients that underwent suture fixation compared to non-anchored controls (11.7 vs. 55%), though logistic regression modeling to determine the independent effect of suture fixation was not performed [2]. Based on currently published literature, the independent effect of suture fixation on esophageal FCSEMS migration remains uncertain.…”

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confidence: 99%

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

et al. 2016

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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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“…Through-the-endoscope clips are of limited value[86,117,118] and limited experience with the new endoscopic suturing devices to anchor the stents shows variable results[119,120]. …”

Section: Anastomotic Leaks and Fistulasmentioning

confidence: 99%

Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results

Souto-Rodríguez¹,

Alvarez-Sánchez²

2017

WJGE

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Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications. There is now evidence in the literature supporting endoscopic management for some of these complications, such as gastrointestinal bleeding, stomal and marginal ulcers, stomal stenosis, leaks and fistulas or pancreatobiliary disorders. However, endoscopic treatment in this setting is not standardized, and there is no consensus on its optimal timing. In this article, we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment. Based on a thorough review of the literature, we evaluated the performance and safety of different endoscopic options for every type of complication, highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.

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Esophageal Stenting With Sutures

Abstract: Anchoring of the upper flare of the FCSEMS with endoscopic sutures is technically feasible and significantly reduces stent migration rate when compared with no suturing, and is a safe procedure with very low AEs rates.

Cited by 27 publications

References 31 publications

Lumen-apposing metal stents for benign gastrointestinal tract strictures: An international multicenter experience

Lumen-apposing metal stents for benign gastrointestinal tract strictures: An international multicenter experience

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

Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results

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