Reduction of esophageal stent migration rate with a novel over-the-scope fixation device (with video)

Schiemer, Moritz; Bettinger, Dominik; Müeller, Jens-Dominik; Schultheiß, Michael; Schwacha, H; Hasselblatt, Peter; Thimme, Robert; Schmidt, Arthur; Kuellmer, Armin

doi:10.1016/j.gie.2022.02.001

Cited by 22 publications

(27 citation statements)

References 21 publications

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“…Nevertheless, the technical obstacles during EDGE could be resolved with the application of larger LAMS to inhibit dislodgement and achieve single session interventions [ 110 ] For example, the risk of stent migration using 15 mm LAMS was significantly greater compared to 20 mm stents (odds ratio: 5.36; 95%CI: 1.29–22.24; p ≤ 0.021). Moreover, stent fixation could, also, be a potential alternative, although further evaluation of this hypothesis is necessary [ 110 ] The background of this rationale is based on the mechanical stabilization of the LAMS, as suggested for esophageal stents [ 111 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

Gkolfakis

Papaefthymiou

Facciorusso

et al. 2022

Life

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Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP), in surgically altered anatomy (SAA), can be challenging and the optimal technique selection remains debatable. Most common foregut interventions resulting to this burden consist of Billroth II gastrectomy, Whipple surgery and Roux-en-Y anastomoses, including gastric by-pass. This systematic review, with meta-analysis, aimed to compare the rates of successful enteroscope-assisted (EA)-, endosonography-directed transgastric- (EDGE), and laparoscopy-assisted (LA)-ERCP. Methods: A systematic research (Medline) was performed for relative studies, through January 2022. The primary outcome was technical success, defined as approaching the ampulla site. Secondary outcomes included the desired duct cannulation, successful therapeutic manipulations, and complication rates. We performed meta-analyses of pooled data, and subgroup analysis considering the EA-ERCP subtypes (spiral-, double and single balloon-enteroscope). Pooled rates are reported as percentages with 95% Confidence Intervals (95%CIs). Results: Seventy-six studies were included (3569 procedures). Regarding primary outcome, EA-ERCP was the least effective [87.3% (95%CI: 85.3–89.4); I2: 91.0%], whereas EDGE and LA-ERCP succeeded in 97.9% (95%CI: 96.4–99.4; I2: 0%) and 99.1% (95%CI: 98.6–99.7; I2: 0%), respectively. Similarly, duct cannulation and therapeutic success rates were 74.7% (95%CI: 71.3–78.0; I2: 86.9%) and 69.1% (95%CI: 65.3–72.9; I2: 91.8%) after EA-ERCP, 98% (95%CI: 96.5–99.6; I2: 0%) and 97.9% (95%CI: 96.3–99.4) after EDGE, and 98.6% (95%CI: 97.9–99.2; I2: 0%) and 98.5% (95%CI: 97.8–99.2; I2: 0%) after LA-ERCP, respectively. The noticed high heterogeneity in EA-ERCP results probably reflects the larger number of included studies, the different enteroscopy modalities and the variety of surgical interventions. Comparisons revealed the superiority of LA-ERCP and EDGE over EA-ERCP (p ≤ 0.001) for all success-related outcomes, though LA-ERCP and EDGE were comparable (p ≥ 0.43). ERCP with spiral-enteroscope was inferior to balloon-enteroscope, while the type of the balloon-enteroscope did not affect the results. Most adverse events were recorded after LA-ERCP [15.1% (95%CI: 9.40–20.8); I2: 87.1%], and EDGE [13.1% (95%CI: 7.50–18.8); I2: 48.2%], significantly differing from EA-ERCP [5.7% (95%CI: 4.50–6.80); p ≤ 0.04; I2: 64.2%]. Conclusions: LA-ERCP and EDGE were associated with higher technical, cannulation, and therapeutic success compared to EA-ERCP, though accompanied with more adverse events.

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Section: Discussionmentioning

confidence: 99%

Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

Gkolfakis

Papaefthymiou

Facciorusso

et al. 2022

Life

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“…Ngamruengphong et al found no statistically significant difference in stent migration rate between PCSEMS and FCSEMS fixed with the OverStitch suturing device (Apollo Endosurgery, Austin, TX, United States) [ 29 ]. Moreover, fixation of FCSEMSs with a novel dedicated over-the-scope clip device, Stentfix OTSC ® (Ovesco Endoscopy, Tubingen, Germany) significantly reduced migration rate compared with unfixed stents [ 30 ].…”

Section: Endoscopic Techniquesmentioning

confidence: 99%

Endoscopic Management of Postoperative Esophageal and Upper GI Defects—A Narrative Review

et al. 2023

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Anastomotic defects are deleterious complications after either oncologic or bariatric surgery, leading to high morbidity and mortality. Besides surgical revision in early stages or instable patients, endoscopic treatment has become the mainstay. To date, many options for endoscopic treatment in this setting exist, including fully covered metal stent placement, endoscopic vacuum therapy (EVT), endoscopic internal drainage with pigtail placement (EID), leak closure with through the scope or over the scope clips, endoluminal suturing, fibrin glue sealing and a combination of all these techniques. Current evidence is mostly based on retrospective single and multicenter studies. No guidelines exist in this important field. Treatment options have to be chosen upon each case individually, taking into account clinical and anatomic criteria, such as timing, size, infectious wound complications and hemodynamic stability. Local expertise and availability of treatment devices need to be taken into account whenever choosing a treatment strategy. This review aimed to present current treatment options in terms of effectiveness, advantages and disadvantages in order to guide the clinician for his decision making. Additionally, we aimed to provide a treatment algorithm.

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“…A pilot study that assessed the efficacy of over-the-scope clips for gastroduodenal stent fixation reported stent migration in only one case (6.7%) ( 77 ). Currently, over-the-scope clips dedicated to stent fixation (OTSC ® STENTFIX, Ovesco Endoscopy AG, Tübingen, Germany) are commercially available ( 78 ). Despite studies dealing with primarily benign diseases, endoscopic suturing was shown to be helpful in mitigating the risk of stent migration ( 79 ).…”

Section: What Kind Of Stent Is Preferable?mentioning

confidence: 99%

How to successfully administer palliative treatment with a stent for malignant gastric outlet obstruction?

Maetani

2022

Front. Med.

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Although endoscopic stenting (ES) has been widely used as a less-invasive palliation method for malignant gastric outlet obstruction (GOO), recent reports have highlighted issues related to the procedure. For successful treatment, various aspects must be assessed before considering the practices. First, it is necessary to eliminate cases with contraindications such as coexistence of distal small-bowel obstruction or perforation. Other factors potentially related to clinical failure (i.e., peritoneal carcinomatosis) may require consideration but remain controversial. ES has better short-term outcomes than surgical gastrojejunostomy (GJ). GJ has recently been considered preferable in cases with longer life expectancy because of superior sustainability. Various types of stents are now commercially available, but their ideal structure and mechanical properties have not yet been clarified. Covered metal stent may reduce stent obstruction but is prone to increase stent migration, and its significance remains uncertain. Subsequent chemotherapy after stenting should be considered, as it is expected to prolong patient survival without increasing the risk of adverse events. Furthermore, it may be helpful in preventing tumor ingrowth. In cases with GOO combined with biliary obstruction, biliary intervention is often difficult. Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been widely used as an alternative procedure for endoscopic transpapillary biliary drainage (ETBD). Despite the lack of consensus as to whether ETBD or EUS-BD is preferred, EUS-BD is useful as a salvage technique for cases where ETBD is difficult. To perform stent placement successfully, it is important to pay attention to the above points; however, many remaining issues need to be clarified in the future.

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Reduction of esophageal stent migration rate with a novel over-the-scope fixation device (with video)

Cited by 22 publications

References 21 publications

Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

Endoscopic Management of Postoperative Esophageal and Upper GI Defects—A Narrative Review

How to successfully administer palliative treatment with a stent for malignant gastric outlet obstruction?

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