title: Fixation of a modified covered esophageal stent: its clinical usefulness for preventing stent migration.
abstract: OBJECTIVE
  Membrane-covered self-expandable metal stents are effective in preventing tumor ingrowth and stent obstruction in patients with inoperable esophageal cancer, but migration of stents continues to be a major problem. We therefore constructed a modified covered self-expandable esophageal metal stent capable of being fixed using a silk thread. The stent was studied prospectively to define its palliative characteristics and whether it is effective in preventing migration.
  
  
  METHODS
  Modified covered self-expandable metal stents were placed in 17 patients with malignant gastric cardiac cancer involving the esophagogastric junction, 41 patients with esophageal cancer, and three patients with tracheoesophageal fistulas. Clinical and radiographic follow-up examinations were carried out at regular intervals.
  
  
  RESULTS
  Placement of the stent was successful in all patients, with good symptomatic relief and no serious stent-related complications such as esophageal perforation or hemorrhage. Acute stent placement problems, such as incomplete expansion or acute angulation of the stent, were noted in four patients. However, during a mean follow-up period of 7.5 months (range 1 to 17 months), there was no stent migration.
  
  
  CONCLUSIONS
  Modified covered self-expandable esophageal metal stents of this type would be very effective in preventing stent migration, especially in patients with malignant gastric cardiac cancer extending to the lower esophagus, those with short-segment esophageal cancer, and those with tracheoesophageal fistulas.
authors.affiliation: Dept. of Internal Medicine, Institute for Digestive Research, Soon Chun Hyang University College of Medicine, Seoul, Korea. schidr@hosp.sch.ac.kr
authors.forename: C S
authors.initials: CS
authors.lastname: Shim
authors.forename: Y D
authors.initials: YD
authors.lastname: Cho
authors.forename: J H
authors.initials: JH
authors.lastname: Moon
authors.forename: J O
authors.initials: JO
authors.lastname: Kim
authors.forename: J Y
authors.initials: JY
authors.lastname: Cho
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
authors.forename: J S
authors.initials: JS
authors.lastname: Lee
authors.forename: M S
authors.initials: MS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D004938:Esophageal Neoplasms / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D015607:Stents / Q000009:adverse effects