Evaluation of the clip anchorage technique using mucosal elevation and incision in prevention of esophageal stent migration.

Background and study aims: Migration remains a frequent and challenging situation following esophageal stent placement. The aims of this study were to evaluate efficiency and safety of a new anchorage technique using through-the-scope (TTS) clips to prevent esophageal stent migration.

Patients and methods: This was a retrospective case-control analysis of a prospective, monocentric database. Patients with a fully-covered esophageal stent, fixed or not for benign or malignant indications, were included. Fixation of the stent at the oral flange was achieved with TTS clips, placed for a bite in submucosal space after injection with saline and mucosal incision using the tip of a snare.

Results: A total of 52 patients were included, 24 stents with anchorage (fixed group) and 28 without (control group). Fixation was more frequently performed for benign disease (75.0% fixed group vs. 39.29% for control, P = 0.021). Median length of stent dwell time was 41.5 days in the fixed group and 30.5 days for controls ( P = 0.263). The overall migration rate was comparable (45.83% in the fixed group vs. 35.71% for controls, P = 0.647). A higher rate of early migration was observed in the control group (60.0% vs 18.18%, P = 0.080). A prior history of radio-chemotherapy was predictive of migration. There was no increased complication rate at placement or at removal in the treated group.

Conclusions: The new esophageal stent fixation technique appears to be simple, inexpensive, feasible, and safe. Although there is no impact on overall migration, there does seem to be a reduction in early migration.