title: Esophageal stent fixation with endoscopic suturing device improves clinical outcomes and reduces complications in patients with locally advanced esophageal cancer prior to neoadjuvant therapy: a large multicenter experience.
abstract: Endoscopic placement of fully covered self-expanding metal stents (FCSEMS) to treat malignant dysphagia in patients with esophageal cancer significantly improves dysphagia; however, these stents have a high migration rate.
  
  
  
  To determine whether FCSEMS fixation using an endoscopic suturing device treated malignant dysphagia and prevented stent migration in patients with locally advanced esophageal cancer receiving neoadjuvant therapy when compared to patients with FCSEMS placement alone.
  
  
  
  A review of patients with locally advanced esophageal cancer who underwent FCSEMS placement at 3 centers was performed. Patients were divided into two groups: Group A (n = 26) was composed of patients who underwent FCSEMS placement with suture placement, and Group B (n = 67) was composed of patients with FCSEMS placement alone.
  
  
  
  There were no significant differences between Groups A and B in demographics, and tumor characteristics. The technical success rate for stent placement was 100 %. There was no difference between Groups A and B in the median stent diameter and stent lengths. Mean dysphagia score obtained at 1 week after stent placement had improved significantly from baseline (2.4 and 1, respectively, p < 0.001). Patients had a median follow-up of 4 months. Immediate adverse events were mild chest discomfort in 4 patients in Group A and 2 patients in Group B (p = 0.05), and significant acid reflux in 3 patient in Group A compared to 2 patients in Group B (p = 0.1). The stent migration rate was significantly lower in Group A compared to compared to Group B (7.7 vs 26.9 %, respectively, p = 0.004). There was a delayed perforation in 1 patient and 1 death due to aspiration pneumonia in Group B.
  
  
  
  Fixation of esophageal FCSEMSs by using an endoscopic suturing device in patients receiving neoadjuvant therapy was shown to be feasible, safe, and relatively effective at preventing stent migration compared to those who had stent placed alone.
authors: Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Juliana
authors: J
authors: Yang
authors: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA. ali.siddiqui@jefferson.edu.
authors: Ali A
authors: 0000-0003-4269-0209
authors: AA
authors: Siddiqui
authors: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors: Thomas E
authors: TE
authors: Kowalski
authors: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors: David E
authors: DE
authors: Loren
authors: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors: Ammara
authors: A
authors: Khalid
authors: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors: Ayesha
authors: A
authors: Soomro
authors: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors: Syed M
authors: SM
authors: Mazhar
authors: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors: Julian
authors: J
authors: Rosé
authors: Division of Gastroenterology, Weill Cornell Medical School, New York, NY, USA.
authors: Laura
authors: L
authors: Isby
authors: Division of Gastroenterology, Weill Cornell Medical School, New York, NY, USA.
authors: Michel
authors: M
authors: Kahaleh
authors: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors: Ankush
authors: A
authors: Kalra
authors: Division of Gastroenterology, Weill Cornell Medical School, New York, NY, USA.
authors: Alex M
authors: AM
authors: Sarkisian
authors: Division of Gastroenterology, Weill Cornell Medical School, New York, NY, USA.
authors: Nikhil A
authors: NA
authors: Kumta
authors: Borland-Groover Clinic, Jacksonville, FL, USA.
authors: Jose
authors: J
authors: Nieto
authors: Division of Gastroenterology, Weill Cornell Medical School, New York, NY, USA.
authors: Reem Z
authors: RZ
authors: Sharaiha
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004939:Esophageal Perforation / Q000453:epidemiology; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology*; D011475:Prosthesis Failure; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D013536:Suture Techniques