title: The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study.
abstract: BACKGROUND
  Migration is the most common complication of the fully covered metallic self-expanding esophageal stent (SEMS). This study aimed to determine the potential preventive effect of proximal fixation on the mucosa by clips for patients treated with fully covered SEMS.
  
  
  METHODS
  In this study, 44 patients (25 males, 57%) were treated with fully covered SEMS including 22 patients with esophageal stricture (4 malignant obstructions, 6 anastomotic strictures, and 12 peptic strictures) and 22 patients with fistulas or perforations (10 anastomotic leaks, 4 perforations, and 8 postbariatric surgery fistulas). The Hanarostent (n = 25), Bonastent (n = 5), Niti-S (n = 12), and HV-stent (n = 2) with diameters of 18 to 22 mm and lengths of 80 to 170 mm were used. Two to four clips (mean, 2.35 ± 0.75 clips) were used consecutively in 23 patients to fix the upper flared end of the stent with the esophageal mucosal layer. Stent migration and its consequences were collected in the follow-up assessment with statistical analysis to compare the patients with and without clip placement.
  
  
  RESULTS
  No complication with clip placement was observed, and the retrieval of the stent was not unsettled by the persistence of at least one clip (12 cases). Stent migration was noted in 15 patients (34%) but in only in 3 of the 23 patients with clips (13%). The number of patients treated to prevent one stent migration was 2.23. The predictive positive value of nonmigration after placement of the clip was 87%. In the multivariate analysis, the fixation with clips was the unique independent factor for the prevention of stent migration (odds ratio, 2.3; 95% confidence interval, 0.10-0.01; p = 0.03).
  
  
  CONCLUSIONS
  Anchoring of the upper flare of the fully covered SEMS with the endoscopic clip is feasible and significantly reduces stent migration.
authors.affiliation: Université de Nice Sophia-Antipolis, Faculté de Médecine, Nice, 06107, France. vanbiervliet.g@chu-nice.fr
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Vanbiervliet
authors.forename: Jérôme
authors.initials: J
authors.lastname: Filippi
authors.forename: Babou Soilihi
authors.initials: BS
authors.lastname: Karimdjee
authors.forename: Nicolas
authors.initials: N
authors.lastname: Venissac
authors.forename: Antonio
authors.initials: A
authors.lastname: Iannelli
authors.forename: Amine
authors.initials: A
authors.lastname: Rahili
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Benizri
authors.forename: Daniel
authors.initials: D
authors.lastname: Pop
authors.forename: Pascal
authors.initials: P
authors.lastname: Staccini
authors.forename: Albert
authors.initials: A
authors.lastname: Tran
authors.forename: Stéphane
authors.initials: S
authors.lastname: Schneider
authors.forename: Jérôme
authors.initials: J
authors.lastname: Mouroux
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
authors.forename: Daniel
authors.initials: D
authors.lastname: Benchimol
authors.forename: Xavier
authors.initials: X
authors.lastname: Hébuterne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D016022:Case-Control Studies; D004386:Duodenum; D004935:Esophageal Diseases / Q000601:surgery*; D004945:Esophagoscopy / Q000295:instrumentation / Q000379:methods; D005243:Feces; D005260:Female; D005548:Foreign-Body Migration / Q000517:prevention & control*; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery; D007416:Intestinal Perforation / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011475:Prosthesis Failure / Q000009:adverse effects*; D015607:Stents / Q000009:adverse effects*; D013270:Stomach; D013525:Surgical Instruments