title: Esophageal Stenting With Sutures: Time to Redefine Our Standards?
abstract: OBJECTIVE
  Migration is the most common complication of the fully covered metallic self-expanding esophageal stent (FCSEMS). Recent studies have demonstrated migration rates between 30% and 60%. The aim of this study was to determine the effect of fixation of the FCSEMS by endoscopic suturing on migration rate.
  
  
  METHODS
  Patients who underwent stent placement for esophageal strictures and leaks over the last year were captured and reviewed retrospectively. Group A, cases, were patients who underwent suture placement and group B, controls, were patients who had stents without sutures. Basic demographics, indications, and adverse events (AEs) were collected. Kaplan-Meier analysis and Cox regression modeling were conducted to determine estimates and predictors of stent migration in patients with and without suture placement.
  
  
  RESULTS
  Thirty-seven patients (18 males, 48.65%), mean age 57.2 years (±16.3 y), were treated with esophageal FCSEMS. A total of 17 patients received sutures (group A) and 20 patients received stents without sutures (group B). Stent migration was noted in a total of 13 of the 37 patients (35%) [2 (11%) in group A and 11 (55%) in group B]. Using Kaplan-Meier analysis and log-rank analysis, fixation of the stent with suturing reduced the risk of migration (P=0.04). There were no AEs directly related to suture placement.
  
  
  CONCLUSIONS
  Anchoring of the upper flare of the FCSEMS with endoscopic sutures is technically feasible and significantly reduces stent migration rate when compared with no suturing, and is a safe procedure with very low AEs rates.
authors.affiliation: *Division of Gastroenterology and Hepatology, Weill Cornell Medical College †Digestive and Liver Diseases, Columbia University Medical Center, New York, NY.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.forename: Nikhil A
authors.initials: NA
authors.lastname: Kumta
authors.forename: Theodore P
authors.initials: TP
authors.lastname: Doukides
authors.forename: Vasco
authors.initials: V
authors.lastname: Eguia
authors.forename: Tamas A
authors.initials: TA
authors.lastname: Gonda
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Widmer
authors.forename: Brian G
authors.initials: BG
authors.lastname: Turner
authors.forename: John M
authors.initials: JM
authors.lastname: Poneros
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.forename: Amrita
authors.initials: A
authors.lastname: Sethi
mesh_terms: D000328:Adult; D000368:Aged; D004935:Esophageal Diseases / Q000601:surgery*; D004940:Esophageal Stenosis / Q000601:surgery; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005548:Foreign-Body Migration / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects*; D013536:Suture Techniques; D013537:Sutures