Evaluating no fixation, endoscopic suture fixation, and an over-the-scope clip for anchoring fully covered self-expandable metal stents in benign upper GI conditions: a comparative multicenter international study (with video) - 01/03/25

Doi : 10.1016/j.gie.2024.08.015

Amit Mehta, MD ¹, Ashraf Ashhab, MD ¹, Apurva Shrigiriwar, MD ¹, Redeat Assefa, MD ¹, Andrew Canakis, DO ², Michael Frohlinger, MD ², Christopher A. Bouvette, MD ³, Gregus Matus, MD ⁴, Paul Punkenhofer, MD ⁴, Francesco Vito Mandarino, MD ⁵, Francesco Azzolini, MD ⁵, Jamil S. Samaan, MD ⁶, Rashmi Advani, MD ⁶, Shivani K. Desai, MD ⁷, Bradley Confer, DO ⁷, Vikas K. Sangwan, MD ⁷, Jonh J. Pineda-Bonilla, MD ⁸, David P. Lee, MD ⁹, Kinnari Modi, MD ⁹, Chiemeziem Eke, MD ⁹, Moritz Schiemer, MD ^10,^⁎ , Elena Rondini, MD ¹¹, Werner Dolak, MD ¹², Emil Agarunov, MD ¹⁵, Margaret Duku, MD ¹³, Andrea Telese, MD ¹³, Rishi Pawa, MD ¹⁴, Swati Pawa, MD ¹⁴, Natividad Zaragoza Velasco, MD ¹⁶, Jad Farha, MD ¹, Rickisha Berrien-Lopez, MD ¹, Sherifatu Abu, MD ¹, Charlee K. McLean-Powell, MD ¹, Raymond E. Kim, MD ², Amir Rumman, MD ³, Georg O. Spaun, MD ⁴, Paolo G. Arcidiacono, MD ⁵, Kenneth H. Park, MD ⁶, Harshit S. Khara, MD ⁷, David L. Diehl, MD ⁷, Prashant Kedia, MD ⁹, Armin Kuellmer, MD ¹⁰, Raffaele Manta, MD ¹¹, Tamas A. Gonda, MD ¹⁵, Vinay Sehgal, MD ¹³, Rehan Haidry, MD ¹³, Mouen A. Khashab, MD ^1,^⁎
¹ Johns Hopkins Medicine, Baltimore, Maryland, USA
² University of Maryland Medical System, Baltimore, Maryland, USA
³ University of Oklahoma, Norman, Oklahoma, USA
⁴ Ordensklinikum Linz, Oberösterreich, Austria
⁵ IRCCS Ospedale San Raffaele, Milano, Italy
⁶ Cedars-Sinai Medical Center, Los Angeles, California, USA
⁷ Geisinger Medical Center, Danville, Pennsylvania, USA
⁸ Lewis Gale Medical Center, Salem, Virginia, USA
⁹ Methodist Dallas Medical Center, Dallas, Texas, USA
¹⁰ Universitatsklinikum Freiburg, Baden-Württemberg, Germany
¹¹ Azienda Ospedaliera di Perugia, Perugia, Italy
¹² Medizinische Universitat Wien, Wien, Austria
¹³ University College London, London, United Kingdom
¹⁴ Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
¹⁵ NYU Langone Health, New York, New York, USA
¹⁶ Hospital Universitari Arnau de Vilanova, Lleida, Catalunya, Spain

^∗Reprint requests: Mouen A. Khashab, MD, Department of Gastroenterology, Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287.Department of GastroenterologyJohns Hopkins University1800 Orleans StBaltimoreMD21287

Abstract

Background and Aims

Fully covered self-expandable metal stents (FCSEMSs) are widely used in benign upper GI conditions, but stent migration remains a limitation. An over-the-scope clip (OTSC) device (Stentfix {SF], Ovesco Endoscopy) for stent anchoring has recently been developed. The aim of this study was to evaluate the effect of OTSC fixation on FCSEMS migration rate.

Methods

In this retrospective review of consecutive patients who underwent FCSEMS placement for benign upper GI conditions from January 2011 to October 2022 at 16 centers, the primary outcome was rate of stent migration. The secondary outcomes were clinical success and adverse events.

Results

A total of 311 (no fixation [NF] 122, SF 94, endoscopic suturing [ES] 95) patients underwent 316 stenting procedures. Compared with the NF group (n = 49, 39%), the rates of stent migration were significantly lower in the SF (n = 16, 17%, P = .001) and ES (n = 23, 24%, P = .01) groups. The rates of stent migration were not different between the SF and ES groups (P = .2). On multivariate analysis, SF (odds ratio [OR], 0.34, 95% CI, 0.17-0.70, P < .01) and ES (OR, 0.46, 95% CI, 0.23-0.91; P = .02) were independently associated with decreased risk of stent migration. Compared with the NF group (n = 64; 52%), there were higher rates of clinical success in the SF (n = 64; 68%; P = .03) and ES (n = 66; 69%; P = .02) groups. There was no significant difference in the rates of adverse events among the 3 groups.

Conclusion

Stent fixation using OTSCs is safe and effective at preventing stent migration and may also result in improved clinical response.

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Graphical abstract

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Abbreviations : AE, ES, FCSEMS, NF, OTSC, SF, TTS, UGI

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Esophageal stent placement

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Vol 101 - N° 3

P. 589-597 - mars 2025 Retour au numéro

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Evaluating no fixation, endoscopic suture fixation, and an over-the-scope clip for anchoring fully covered self-expandable metal stents in benign upper GI conditions: a comparative multicenter international study (with video) - 01/03/25

Abstract

Background and Aims

Methods

Results

Conclusion

Graphical abstract

Plan

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