Evaluation of the clip anchorage technique using mucosal elevation and incision in prevention of esophageal stent...

Migration remains a frequent and challenging situation following esophageal stent placement. The aims of this study were to evaluate efficiency and safety of a new anchorage technique using through-the-scope (TTS) clips to prevent esophageal stent migration.

This was a retrospective case-control analysis of a prospective, monocentric database. Patients with a fully-covered esophageal stent, fixed or not for benign or malignant indications, were included. Fixation of the stent at the oral flange was achieved with TTS clips, placed for a bite in submucosal space after injection with saline and mucosal incision using the tip of a snare.

A total of 52 patients were included, 24 stents with anchorage (fixed group) and 28 without (control group). Fixation was more frequently performed for benign disease (75.0% fixed group vs. 39.29% for control, P = 0.021). Median length of stent dwell time was 41.5 days in the fixed group and 30.5 days for controls ( P = 0.263). The overall migration rate was comparable (45.83% in the fixed group vs. 35.71% for controls, P = 0.647). A higher rate of early migration was observed in the control group (60.0% vs 18.18%, P = 0.080). A prior history of radio-chemotherapy was predictive of migration. There was no increased complication rate at placement or at removal in the treated group.

The new esophageal stent fixation technique appears to be simple, inexpensive, feasible, and safe. Although there is no impact on overall migration, there does seem to be a reduction in early migration.