title: Endoscopic suture fixation is associated with reduced migration of esophageal fully covered self-expandable metal stents (FCSEMS).
abstract: Esophageal fully covered self-expandable metal stents (FCSEMS) are indicated for the management of benign and malignant conditions of the esophagus including perforations, leaks, and strictures. FCSEMS are resistant to tissue ingrowth and are removable; however, stent migration occurs in 30-55% of cases. Endoscopic suture fixation of FCSEMS has been utilized to decrease the risk of stent migration though data supporting this practice remain limited. The primary aim of this study was to compare clinical outcomes and migration rate of patients who underwent placement of esophageal FCSEMS with and without endoscopic suture fixation.
  
  
  
  Our single-center, retrospective, cohort study includes patients who underwent esophageal FCSEMS placement with and without endoscopic suture fixation between January 1, 2012, and November 11, 2015. Baseline patient characteristics, procedural details, and clinical outcomes were abstracted. Logistic regression was performed to identify clinical and technical factors associated with outcomes and stent migration.
  
  
  
  A total of 51 patients underwent 62 FCSEMS placements, including 21 procedures with endoscopic suture fixation and 41 without. Suture fixation was associated with reduced risk of stent migration (OR 0.13, 95% CI 0.03-0.47). Prior stent migration was associated with significantly higher risk of subsequent migration (OR 6.4, 95% CI 1.6-26.0). Stent migration was associated with lower likelihood of clinical success (OR 0.21, 95% CI 0.06-0.69). There was a trend toward higher clinical success among patients undergoing suture fixation (85.7 vs. 60.9%, p = 0.07).
  
  
  
  Endoscopic suture fixation of FCSEMS was associated with a reduced stent migration rate. Appropriate patient selection for suture fixation of FCSEMS may lead to reduced migration in high-risk patients.
authors.affiliation: Division of Gastroenterology, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Dr., SPC 5362, Ann Arbor, MI, 48109-5362, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wright
authors.affiliation: Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Chang
authors.affiliation: Division of Gastroenterology, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Dr., SPC 5362, Ann Arbor, MI, 48109-5362, USA.
authors.forename: Aarti Oza
authors.initials: AO
authors.lastname: Bedi
authors.affiliation: Division of Gastroenterology, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Dr., SPC 5362, Ann Arbor, MI, 48109-5362, USA.
authors.forename: Erik-Jan
authors.initials: EJ
authors.lastname: Wamsteker
authors.affiliation: Division of Gastroenterology, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Dr., SPC 5362, Ann Arbor, MI, 48109-5362, USA.
authors.forename: Grace
authors.initials: G
authors.lastname: Elta
authors.affiliation: Division of Gastroenterology, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Dr., SPC 5362, Ann Arbor, MI, 48109-5362, USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Kwon
authors.affiliation: Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Carrott
authors.affiliation: Digestive Disease Center, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Elmunzer
authors.affiliation: Division of Gastroenterology, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Dr., SPC 5362, Ann Arbor, MI, 48109-5362, USA. rjlaw@umich.edu.
authors.forename: Ryan
authors.initials: R
authors.lastname: Law
mesh_terms: D000328:Adult; D000368:Aged; D004945:Esophagoscopy; D005260:Female; D005548:Foreign-Body Migration / Q000517:prevention & control*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D013536:Suture Techniques; D016896:Treatment Outcome
keywords: Fully covered self-expandable metal stent; Stent migration; Suture fixation