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Endoscopy 2016; 48(09): 802-808
DOI: 10.1055/s-0042-108567
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic suturing for the prevention of stent migration in benign upper gastrointestinal conditions: a comparative multicenter study

Saowanee Ngamruengphong   *
1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Reem Z. Sharaiha   *
2   Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
,
Amrita Sethi
3   Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
,
Ali A. Siddiqui
4   Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
,
Christopher J. DiMaio
5   Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
,
Susana Gonzalez
5   Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
,
Jennifer Im
5   Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
,
Jason N. Rogart
6   Capital Health Center for Digestive Health, Pennington, New Jersey, USA
,
Sophia Jagroop
7   North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, USA
,
Jessica Widmer
7   North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, USA
,
Raza Abbas Hasan
4   Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
,
Sobia Laique
4   Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
,
Tamas Gonda
3   Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
,
John Poneros
3   Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
,
Amit Desai
2   Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
,
Amy Tyberg
2   Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
,
Vivek Kumbhari
1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Mohamad El Zein
1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Ahmed Abdelgelil
1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Sepideh Besharati
1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Ruben Hernaez
1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Patrick I. Okolo
1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Vikesh Singh
1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Anthony N. Kalloo
1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Michel Kahaleh
2   Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
,
Mouen A. Khashab
1   Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
› Author Affiliations
Further Information

Publication History

submitted02 May 2015

accepted after revision19 April 2016

Publication Date:
29 June 2016 (online)

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Endoscopic suturing for the prevention of stent migration in benign upper gastrointestinal conditions: a comparative multicenter study Endoscopy 2016; 48(09): 808-808
DOI: 10.1055/s-0042-113997

Background and study aims: Fully covered self-expandable metal stents (FCSEMSs) have increasingly been used in benign upper gastrointestinal (UGI) conditions; however, stent migration remains a major limitation. Endoscopic suture fixation (ESF) may prevent stent migration. The aims of this study were to compare the frequency of stent migration in patients who received endoscopic suturing for stent fixation (ESF group) compared with those who did not (NSF group) and to assess the impact of ESF on clinical outcome.

Patients and methods: This was a retrospective study of patients who underwent FCSEMS placement for benign UGI diseases. Patients were divided into either the NSF or ESF group. Outcome variables, including stent migration, clinical success (resolution of underlying pathology), and adverse events, were compared.

Results: A total of 125 patients (44 in ESF group, 81 in NSF group; 56 benign strictures, 69 leaks/fistulas/perforations) underwent 224 stenting procedures. Stent migration was significantly more common in the NSF group (33 % vs. 16 %; P = 0.03). Time to stent migration was longer in the ESF group (P = 0.02). ESF appeared to protect against stent migration in patients with a history of stent migration (adjusted odds ratio [OR] 0.09; P = 0.002). ESF was also significantly associated with a higher rate of clinical success (60 % vs. 38 %; P = 0.03). Rates of adverse events were similar between the two groups.

Conclusions: Endoscopic suturing for stent fixation is safe and associated with a decreased migration rate, particularly in patients with a prior history of stent migration. It may also improve clinical response, likely because of the reduction in stent migration.

* Contributed equally to this manuscript


 

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