Evaluation of a new fixation technique on prevention of esophageal stents migration in benign disease: the double clip-rubber band technique (with video).

BACKGROUND

Fully covered self-expandable metallic stents (FCSEMS) are suggested for the treatment of benign esophageal disease. However, their main inconvenience is the risk of migration. To prevent migration, fixation techniques have been developed with a controversial efficacy or difficulty to use. The aim of this study was to evaluate a fixation technique "double clip‑rubber band" (DCRB) to prevent stent migration and compare these outcomes without fixation and fixation with through‑the‑scope (TTS) clip.

METHODS

This is a monocentric retrospective study. Consecutive patients who benefited from FCSEMS placement for benign indications between January 2015 and September 2022 were included. The primary outcome was to compare the rate of stent migration according to the fixation technique by procedure. Secondary outcomes were to compare technical and stent removal success, clinical success, and adverse events rates. Univariate and multivariate analyses were performed to evaluate risk factors of stent migration.

RESULTS

A total of 81 patients underwent 146 FCSEMS placements, including 25 procedures with DCRB (17.1%), 73 with TTS (50%), and 48 unfixed (32.9%). The stent migration rate was significantly lower in the DCRB group than in the TTS clips and unfixed groups (8%, 52.1%, and 47.9%, respectively; p < 0.001), with reduced risk of migration in univariate (p < 0.001) and multivariate analyses (p = 0.003).

CONCLUSION

The DCRB technique was associated with significantly lower migration in benign esophageal disease, compared with fixation with TTS or without fixation. These promising results need to be confirmed by a randomized control trial.