title: Endoscopic suturing for the prevention of stent migration in benign upper gastrointestinal conditions: a comparative multicenter study.
abstract: OBJECTIVE
  Fully covered self-expandable metal stents (FCSEMSs) have increasingly been used in benign upper gastrointestinal (UGI) conditions; however, stent migration remains a major limitation. Endoscopic suture fixation (ESF) may prevent stent migration. The aims of this study were to compare the frequency of stent migration in patients who received endoscopic suturing for stent fixation (ESF group) compared with those who did not (NSF group) and to assess the impact of ESF on clinical outcome.
  
  
  METHODS
  This was a retrospective study of patients who underwent FCSEMS placement for benign UGI diseases. Patients were divided into either the NSF or ESF group. Outcome variables, including stent migration, clinical success (resolution of underlying pathology), and adverse events, were compared.
  
  
  RESULTS
  A total of 125 patients (44 in ESF group, 81 in NSF group; 56 benign strictures, 69 leaks/fistulas/perforations) underwent 224 stenting procedures. Stent migration was significantly more common in the NSF group (33 % vs. 16 %; P = 0.03). Time to stent migration was longer in the ESF group (P = 0.02). ESF appeared to protect against stent migration in patients with a history of stent migration (adjusted odds ratio [OR] 0.09; P = 0.002). ESF was also significantly associated with a higher rate of clinical success (60 % vs. 38 %; P = 0.03). Rates of adverse events were similar between the two groups.
  
  
  CONCLUSIONS
  Endoscopic suturing for stent fixation is safe and associated with a decreased migration rate, particularly in patients with a prior history of stent migration. It may also improve clinical response, likely because of the reduction in stent migration.
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Saowanee
authors.initials: S
authors.lastname: Ngamruengphong
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA.
authors.forename: Amrita
authors.initials: A
authors.lastname: Sethi
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Siddiqui
authors.affiliation: Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: DiMaio
authors.affiliation: Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Susana
authors.initials: S
authors.lastname: Gonzalez
authors.affiliation: Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Im
authors.affiliation: Capital Health Center for Digestive Health, Pennington, New Jersey, USA.
authors.forename: Jason N
authors.initials: JN
authors.lastname: Rogart
authors.affiliation: North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, USA.
authors.forename: Sophia
authors.initials: S
authors.lastname: Jagroop
authors.affiliation: North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Widmer
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Raza Abbas
authors.initials: RA
authors.lastname: Hasan
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Sobia
authors.initials: S
authors.lastname: Laique
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA.
authors.forename: Tamas
authors.initials: T
authors.lastname: Gonda
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA.
authors.forename: John
authors.initials: J
authors.lastname: Poneros
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Desai
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Tyberg
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumbhari
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Mohamad
authors.initials: M
authors.lastname: El Zein
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdelgelil
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Besharati
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Ruben
authors.initials: R
authors.lastname: Hernaez
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Patrick I
authors.initials: PI
authors.lastname: Okolo
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Vikesh
authors.initials: V
authors.lastname: Singh
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.affiliation: Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
mesh_terms: D000328:Adult; D000368:Aged; D004378:Duodenal Diseases / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal; D004935:Esophageal Diseases / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000209:etiology*; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects*; D013272:Stomach Diseases / Q000628:therapy*; D013536:Suture Techniques; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome