Esophageal Stent Fixation with Endoscopic Suturing Device Improves Clinical Outcomes

by: Jose Nieto, D.O., A.G.A.F., F.A.C.P., F.A.C.G., F.A.S.G.E.

Authors include: Dr. Yang and Dr. Siddiqui are joint first authors on this manuscript. Ali A. Siddiqui, Julian Tang, Thomas E. Kowalski, David E. Loren, Ammara Khalid, Ayesha Soomro, Syed M. Mazhar, Julian Rosé, Laura Isby, Michel Kahaleh, Ankush Kalra, Alex M. Sarkisian, Nikhil A. Kumta, Jose Nieto, Reem Z. Sharaiha

Esophageal stent fixation with endoscopic suturing device improves clinical outcomes and reduces complications in patients with locally advanced esophageal cancer prior to neoadjuvant therapy: a large multicenter experience.

 

Abstract

Background

Endoscopic placement of fully covered self-expanding metal stents (FCSEMS) to treat malignant dysphagia in patients with esophageal cancer significantly improves dysphagia; however, these stents have a high migration rate.

Aim

To determine whether FCSEMS fixation using an endoscopic suturing device treated malignant dysphagia and prevented stent migration in patients with locally advanced esophageal cancer receiving neoadjuvant therapy when compared to patients with FCSEMS placement alone.

Method

A review of patients with locally advanced esophageal cancer who underwent FCSEMS placement at 3 centers was performed. Patients were divided into two groups: Group A (n = 26) was composed of patients who underwent FCSEMS placement with suture placement, and Group B (n = 67) was composed of patients with FCSEMS placement alone.

Results

There were no significant differences between Groups A and B in demographics, and tumor characteristics. The technical success rate for stent placement was 100 %. There was no difference between Groups A and B in the median stent diameter and stent lengths. Mean dysphagia score obtained at 1 week after stent placement had improved significantly from baseline (2.4 and 1, respectively, p < 0.001). Patients had a median follow-up of 4 months. Immediate adverse events were mild chest discomfort in 4 patients in Group A and 2 patients in Group B (p = 0.05), and significant acid reflux in 3 patient in Group A compared to 2 patients in Group B (p = 0.1). The stent migration rate was significantly lower in Group A compared to compared to Group B (7.7 vs 26.9 %, respectively, p = 0.004). There was a delayed perforation in 1 patient and 1 death due to aspiration pneumonia in Group B.

Conclusion

Fixation of esophageal FCSEMSs by using an endoscopic suturing device in patients receiving neoadjuvant therapy was shown to be feasible, safe, and relatively effective at preventing stent migration compared to those who had stent placed alone.

Electronic supplementary material

The online version of this article (doi:10.1007/s00464-016-5131-3) contains supplementary material, which is available to authorized users.

Supplementary material


View video

Placement of an esophageal FCSEMS followed by endoscopic suturing of the proximal end of the stent using the OverStitch device.

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