Use of loop and clips to prevent migration of esophageal stent

A 25-year-old gentleman presented with dysphagia for solids and liquids. He had a history of accidental ingestion of high-temperature melted iron particles 4 weeks back while working in the iron industry. Upper gastrointestinal endoscopy revealed a stricture with ulceration in the lower esophagus at 35 cm from the incisors ([Fig. 1]). The 9.8-mm diameter endoscope could not be negotiated beyond the stricture site; further examination with a 5.5-mm-diameter endoscope revealed a stricture length of 3 cm and normal gastric mucosa. The patient underwent four sessions of dilatation with Savary-Gilliard dilators up to 15 mm, but the stricture persisted. A fully covered esophageal self-expandable metal stent (18 × 100 mm; Wallflex, Boston Scientific) was deployed as a rescue treatment ([Fig. 2]). In view of the risk of migration, the stent was fixed to the esophageal wall with the help of an endoloop and clips ([Video 1]). A 30-mm endoloop (model no. MAJ-254; Olympus) was grasped with a forceps and partially pulled inside the channel ([Fig. 3]). The endoloop was released near the upper margin of the stent. One end of the loop was fixed with the help of through-the-scope clips (HX-610-090 L, Olympus) to the upper part of the stent ([Fig. 4]). Six clips were applied to fix the endoloop to the esophageal wall.

Fig. 1 Esophageal stricture with ulcerated surrounding mucosa.

Fig. 2 Self-expandable metal stent deployed at the stricture site.

Video 1 Application of endoloop and clips to fix a self-expandable metal stent to the esophageal wall in order to prevent migration.

Fig. 3 Endoloop pulled inside the endoscope channel.

Fig. 4 Fixation of the loop to the upper part of the stent with the help of through-the-scope clips.

Fully covered metal stents are effective treatment for benign esophageal disease, but migration of the stent remains an important issue [1]. Various techniques have been used to prevent the migration of an esophageal stent. Over-the-scope clips [2], Shim technique [3], a suturing device [4], and a mucosal flap technique [5] have all been used to fix the stent. We have described a new technique using the widely available endoloop and through-the-scope clips.

Endoscopy_UCTN_Code_TTT_1AO_2AZ

Publication History

Article published online:
27 January 2021

• References

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