Nasojejunal‐stent technique: A new system to prevent fully covered metal stent migration in the treatment of benign esophageal diseases

Abstract

BRIEF EXPLANATIONF ULLY COVERED SELF-EXPANDABLE metal stents (FCSEMS) have been used for the treatment of benign esophageal conditions such as perforation, leaks, and strictures, 1 and high clinical success is reported. 2 Different anchoring methods have been described (clips, suturing devices, over-the-scope clips and Shim technique 2 ), because of high migration rates (4-36%). 3,4 However, not all cases are candidates, mostly in "difficult" cases where enteral feeding is needed. 5 We report the use of the nasojejunalstent technique (NJST) to prevent migration of FCSEMS in three difficult cases.An 83-year-old man presented to the specialties hospital with hematemesis and hypovolemic shock. After resuscitation, a Sengstaken-Blakemore tube was placed and when (a) (b) (c) (d) (e) (f) Figure 1 (a) Left-sided esophageal perforation at the gastroesophageal junction level with a length of 40 mm (Boerhaave syndrome). (b) Mediastinal view throughout the esophageal perforation. (c) Endoscopic closure could not be done; therefore, a fully covered self-expandable metal stent (FCSEMS) of 18 mm 9 153 mm was placed. (d) Nasojejunal-stent technique was applied in order to avoid stent migration (retroflexion view). (e) Frontal view throughout the FCSEMS. (f) Finally, grasping of both "lassos" is carried out with a conventional hemostatic clip.