Fully-covered esophageal stent migration rates in benign and malignant disease: a multicenter retrospective study

Abstract

Background and study aims Stent migration is a common complication of fully-covered self-expanding metal stents (FCSEMS), but the rate of clinically relevant migration as defined by stent migration followed by reintervention via endoscopy for stent replacement is unknown. The goal of this study is to gain insight into the total migration rate and clinically relevant migration rate of different types of FCSEMS placed within benign and malignant strictures with specific attention paid to stent manufacturer, diameter, and length.

Patients and methods Multicenter retrospective analysis of endoscopic data from patients with FCSEMS placed within benign or malignant strictures. FCSEMS used included a variety of sizes and manufacturers.

Results A total of 369 patients were included, 161 of whom had benign strictures and 208 of whom had malignant strictures. The total migration rate and clinically relevant migration rate in benign strictures were 30 % and 17 %, respectively. For benign strictures, Wallflex stents had a clinically relevant migration rate of 15 %, compared to Endomaxx stents with 19 %, and Evolution stents with 25 % (P = 0.52). The total migration rate and clinically relevant migration rates in malignant strictures were 23 % and 14 %, respectively. Evolution stents had a significantly higher clinically relevant migration rate (29 %) than the Wallflex stents (7 %) and the endomaxx stents (12 %), P = 0.003.

Conclusion This study is the largest to investigate migration rates for FCSEMS in benign and malignant strictures. Clinically relevant migration is a relatively common occurrence with all stent types studied and better anti-migration features are needed.

• References

• 1 Sharma P, Kozarek R. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol 2010; 105: 258-273
• 2 Celestin LR. Permanent intubation in inoperable cancer of the oesophagus and cardia. Ann R Coll Surg Engl 1959; 25: 165-70
• 3 Provan JL. Use of Celestin tube for palliation of malignant oesophageal obstruction. Thorax 1969; 24: 599-602
• 4 van Boeckel PG, Siersema PD. Refractory esophageal strictures: what to do when dilation fails. Curr Treat Options Gastroenterol 2015; 13: 47-58
• 5 Vermeulen BD, Siersema PD. Esophageal stenting in clinical practice: an overview. Curr Treat Options Gastroenterol 2018; 16: 260-273
• 6 Siddiqui AA, Sarkar A, Beltz S. et al. Placement of fully covered self-expandable metal stents in patients with locally advanced esophageal cancer before neoadjuvant therapy. Gastrointest Endosc 2012; 76: 44-51
• 7 Fuccio L, Hassan C, Frazzoni L. et al. Clinical outcomes following stent placement in refractory benign esophageal stricture: a systematic review and meta-analysis. Endoscopy 2016; 48: 141-148
• 8 Bakken J, Wong Kee Song L. et al. Use of a fully covered self-expandable metal stent for the treatment of benign esophageal diseases. Gastrointest Endosc 2010; 72: 712-720
• 9 Senousy B, Gupte A, Draganov P. et al. Fully covered Alimaxx esophageal metal stents in the endoscopic treatment of benign esophageal diseases. Dig Dis Sci 2010; 55: 3399-3403
• 10 Eloubeidi M, Talreja J, Lopes T. et al. Success and complications associated with placement of fully covered removable self-expandable metal stents for benign esophageal diseases (with videos). Gastrointest Endosc 2011; 73: 673-681
• 11 Suzuki T, Siddiqui A, Taylor LJ. et al. Clinical outcomes, efficacy, and adverse events in patients undergoing esophageal stent placement for benign indications. J Clin Gastroenterol 2016; 50: 373-378
• 12 Martinez JC, Puc MM, Quiros RM. Esophageal stenting in the setting of malignancy. ISRN Gastroenterology 2011; 2011: 719575
• 13 Shenfine J, McNamee P, Steen N. et al. A pragmatic randomised controlled trial of the cost-effectiveness of palliative therapies for patients with inoperable oesophageal cancer. Health Tech Assess 2005; 9: 1-121