Feasibility of esophageal stent fixation with an over-the-scope-clip for malignant esophageal strictures to prevent migration

Abstract

Background and study aims Fixation of an esophageal self-expandable metal stent (SEMS) with an over-the-scope-clip (OTSC) system for a benign stricture to prevent migration has been reported. However, the efficacy of SEMS fixation with an OTSC for malignant esophageal stricture remains unclear. The aim of this retrospective study was to evaluate the feasibility of SEMS fixation with an OTSC for a malignant esophageal stricture.

Patients and methods Twelve patients who underwent esophageal SEMS placement and fixation with an OTSC for a malignant esophageal stricture were included in this retrospective study. The primary endpoint was technical success. The secondary endpoint was clinical success, which was defined as an improvement of at least 1 grade in the dysphagia score 1 week after SEMS placement or changes in the dysphagia score from before SEMS placement to 1 week after SEMS placement.

Results The technical success rate was 100 %. The clinical success rate was 92.3 %. In 6 mild stricture cases in which a standard peroral endoscope could be used, no migration of the SEMS was observed. The median dysphagia score before and at 1 week after SEMS placement was 3 (range 2 – 4) and 0 (0 – 4), respectively, which indicated improvement at 1 week after SEMS placement compared with before SEMS placement (P = 0.002). There were no adverse events associated with placement of SEMS and deployment of an OTSC.

Conclusions SEMS fixation with an OTSC is feasible for prevention of migration due to a malignant esophageal stricture.

• References

• 1 Evans JA, Early DS, Chandraskhara V. et al. The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointest Endosc 2013; 77: 328-334
• 2 Hindy P, Hong J, Lam-Tsai Y. et al. A comprehensive review of esophageal stents. Gastroenterol Hepatol 2012; 8: 526-534
• 3 Na HK, Song HY, Kim JH. et al. How to design the optimal self-expandable oesophageal metallic stents: 22 years of experience in 645 patients with malignant strictures. Eur Radiol 2013; 23: 786-796
• 4 Spaander MC, Baron TH, Siersema PD. et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 939-948
• 5 Martins BC, Retes FA, Medrado BF. et al. Endoscopic management and prevention of migrated esophageal stents. World J Gastrointest Endosc 2014; 6: 49-54
• 6 Vleggaar FP, Siersema PD. Expandable stents for malignant esophageal disease. Gastrointest Endosc Clin N Am 2011; 21: 377-388
• 7 Schoppmann SF, Langer FB, Prager G. et al. Outcome and complications of long-term self-expanding esophageal stenting. Dis Esophagus 2013; 26: 154-158
• 8 Park JH, Song HY, Kim JH. et al. Polytetrafluoroethylene-covered retrievable expandable nitinol stents for malignant esophageal obstructions: factors influencing the outcome of 270 patients. AJR Am J Roentgenol 2012; 199: 1380-1386
• 9 Spinelli P, Cerrai FG, Ciuffi M. et al. Endoscopic stent placement for cancer of the lower esophagus and gastric cardia. Gastrointest Endosc 1994; 40: 455-457
• 10 Monkemuller K, Peter S, Toshniwal J. et al. Multipurpose use of the ‘Bear claw’ (over-the-scope-clip system) to treat endoluminal gastrointestinal disorders. Dig Endosc 2014; 26: 350-357
• 11 Sulz MC, Bertolini R, Frei R. et al. Multipurpose use of the over-the-scope-clip system (“Bear claw”) in the gastrointestinal tract: Swiss experience in a tertiary center. World J Gastroenterol 2014; 20: 16287-16292
• 12 Irani S, Baron TH, Gluck M. et al. Preventing migration of fully covered esophageal stents with an over-the-scope clip device (with videos). Gastrointest Endosc 2014; 79: 844-851
• 13 Mudumbi S, Velazquez-Avina J, Neumann H. et al. Anchoring of self-expanding metal stents using the over-the-scope clip, and a technique for subsequent removal. Endoscopy 2014; 46: 1106-1109
• 14 Knyrim K, Wagner HJ, Bethge N. et al. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med 1993; 329: 1302-1307
• 15 Shim CS, Cho YD, Moon JH. et al. Fixation of a modified covered esophageal stent: its clinical usefulness for preventing stent migration. Endoscopy 2001; 33: 843-848
• 16 da Costa Martins B, Medrado BF, de Lima MS. et al. Esophageal metallic stent fixation with dental floss: a simple method to prevent migration. Endoscopy 2013; 45: E342
• 17 Kato H, Fukuchi M, Miyazaki T. et al. Endoscopic clips prevent self-expandable metallic stent migration. Hepato-Gastroenterology 2007; 54: 1388-1390
• 18 Vanbiervliet G, Filippi J, Karimdjee BS. et al. The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study. Surg Endosc 2012; 26: 53-59
• 19 Reijm AN, Didden P, Bruno MJ. et al. Early pain detection and management after esophageal metal stent placement in incurable cancer patients: A prospective observational cohort study. Endosc Int Open 2016; 4: E890-894
• 20 Baron TH, Song LM, Ross A. et al. Use of an over-the-scope clipping device: multicenter retrospective results of the first U.S. experience (with videos). Gastrointest Endosc 2012; 76: 202-208