Endoscopic clips prevent self-expandable metallic stent migration.
OBJECTIVE
Self-expandable metallic stents (SEMS) have been used for many years in the palliation of esophageal cancer symptoms. Stent migration is one of the most recognized complications of SEMS. To prevent SEMS migration, this study reported the use of endoscopic clips, and carefully analyzed the patients who underwent implantation.


METHODS
From January 2000 to December 2002, nine patients consecutively underwent SEMS implantation. After successful placement of the SEMS and to maintain its position, endoscopic clips were used to fix the branch of the upper end of the stent to the esophageal mucosa.


RESULTS
Stent implantation was technically successful in all patients, three of whom had strictures and six of whom had digestive-respiratory fistulas. No stent migration was observed in any of the patients, and dysphagia improved significantly after stent placement. Five patients did, however, experience delayed complications, two in the form of obstructions, two with recurrent fistulas, and one with a perforation.


CONCLUSIONS
In conclusion, this new technique is recommended as endoscopic clipping can diminish the risks of stent migration, in particular those associated with esophago-respiratory fistulas without luminal obstruction.
Kato
Hiroyuki
H
Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, Maebashi, Japan. hiroyuki@po.wind.ne.jp
Fukuchi
Minoru
M
Miyazaki
Tatsuya
T
Manda
Ryokuhei
R
Faried
Ahmad
A
Takita
Junko
J
Nakajima
Masanobu
M
Sohda
Makoto
M
Fukai
Yasuyuki
Y
Masuda
Norihiro
N
Tsukada
Katsuhiko
K
Kuwano
Hiroyuki
H
D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005548:Foreign-Body Migration / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents / Q000009:adverse effects*