title: Esophageal covered stent fixation using an endoscopic over-the-scope clip. Mechanical proof of the concept and first clinical experience.
abstract: OBJECTIVE
  Endoscopic suturing reduces stent migration, but is challenging and time-consuming. We compare endoscopic suturing versus anchoring with a novel over-the-scope clip (Padlock) to fix esophageal stents. Additionally, the first clinical case of Padlock stent fixation is reported.
  
  
  METHODS
  A fully covered esophageal stent was placed in 11 pigs and fixed with one figure-of-eight suture (n = 5) or with a Padlock (n = 4) or not fixed (controls; n = 2). The force required to mobilize the stent was recorded.
  
  
  METHODS
  an esophageal stent was fixed with a Padlock and endoscopically removed 1 month later, in an 82-year-old patient.
  
  
  RESULTS
  Mean force (newton) to mobilize the stent was similar after suturing and Padlock fixation (23.99 ± 14.91 vs. 19.97 ± 7.62; p = 0.32). In controls was 7 and 11 Newtons. Suturing time (seconds) was longer than Padlock application (455.4 ± 144.83 vs. 155 ± 12.9; p = 0.002).
  
  
  METHODS
  stent fixation was feasible and uncomplicated. Removal was easy, and only mild bleeding occurred.
  
  
  CONCLUSIONS
  Padlock is faster than endoscopic suturing and achieves similar stent fixation. The first clinical case confirms the feasibility of the method.
authors: IRCAD, Research Institute Against Cancer of Digestive System, Strasbourg, France. michele.diana@ircad.fr.|IHU-Strasbourg, University Institute for Minimally-Invasive Hybrid Image-Guided Therapies, 1, Place de l'Hôpital, 67091, Strasbourg, France. michele.diana@ircad.fr.
authors: Michele
authors: M
authors: Diana
authors: IHU-Strasbourg, University Institute for Minimally-Invasive Hybrid Image-Guided Therapies, 1, Place de l'Hôpital, 67091, Strasbourg, France. lee.swanstrom@ihu-strasbourg.eu.|Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France. lee.swanstrom@ihu-strasbourg.eu.
authors: Lee L
authors: LL
authors: Swanström
authors: IHU-Strasbourg, University Institute for Minimally-Invasive Hybrid Image-Guided Therapies, 1, Place de l'Hôpital, 67091, Strasbourg, France.
authors: Peter
authors: P
authors: Halvax
authors: IHU-Strasbourg, University Institute for Minimally-Invasive Hybrid Image-Guided Therapies, 1, Place de l'Hôpital, 67091, Strasbourg, France.
authors: Andras
authors: A
authors: Lègner
authors: IRCAD, Research Institute Against Cancer of Digestive System, Strasbourg, France.
authors: Yu-Yin
authors: YY
authors: Liu
authors: IHU-Strasbourg, University Institute for Minimally-Invasive Hybrid Image-Guided Therapies, 1, Place de l'Hôpital, 67091, Strasbourg, France.
authors: Amilcar
authors: A
authors: Alzaga
authors: Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.
authors: Antonio
authors: A
authors: D'Urso
authors: IRCAD, Research Institute Against Cancer of Digestive System, Strasbourg, France.|IHU-Strasbourg, University Institute for Minimally-Invasive Hybrid Image-Guided Therapies, 1, Place de l'Hôpital, 67091, Strasbourg, France.|Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.
authors: Jacques
authors: J
authors: Marescaux
mesh_terms: D000369:Aged, 80 and over; D000818:Animals; D020701:Esophagoscopes; D004945:Esophagoscopy / Q000295:instrumentation* / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D015607:Stents; D013536:Suture Techniques; D013552:Swine
keywords: Aponos clip; Clips; Endoscopic suturing; Fully covered self-expandable metal stents; Overstitch; Stent fixation; Stent, stent migration
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