title: Endoscopic suturing of esophageal fully covered self-expanding metal stents reduces rates of stent migration.
abstract: OBJECTIVE
  Endoscopic suturing of fully covered self-expanding metal stents (FC-SEMSs) may prevent migration. The aim of this study was to compare rates of migration between sutured FC-SEMSs (S-FCSEMSs), unsecured FC-SEMSs, and partially covered SEMSs (PC-SEMSs) placed for benign esophageal leaks and strictures.
  
  
  METHODS
  In a retrospective, single-center, cohort study, rates of migration for S-FCSEMSs, FC-SEMSs, and PC-SEMSs were assessed in patients with at least 1 month of follow-up or experiencing clinically significant stent migration (CSSM) any time after placement. CSSM was defined as proximal or distal displacement of the stent by ≥2 cm or passage into the stomach plus the recurrence of pre-SEMS symptoms or signs. A multivariable analysis was done to identify additional risk factors for stent migration.
  
  
  RESULTS
  A total of 184 SEMSs were placed in 101 patients, including 32 S-FCSEMSs in 25 patients, 114 FC-SEMSs in 59 patients, and 38 PC-SEMSs in 30 patients. CSSM occurred with 56 of 184 stents (30.4%) in 36 of 101 patients (35.6%), including 3 of 32 (9.4%) S-FCSEMSs, 45 of 114 (39.5%) FC-SEMSs, and 8 of 38 (21.1%) PC-SEMSs (P = .005). Migration was less likely for S-FCSEMSs than for FC-SEMSs (9.4% vs 39.5%; P = .01) but not between S-FCSEMSs and PC-SEMSs (9.4% vs 21.1%; P = .07) or between FC-SEMSs and PC-SEMSs (39.5% vs 21.1%; P = .38). Previous stent migration (odds ratio [OR], 3.93; 95% confidence interval [CI], 1.88-8.19; P = .01) and previous esophageal surgery (OR, 0.33; 95% CI, 0.16-0.67; P = .002) were associated with increased and decreased risk of CSSM, respectively.
  
  
  CONCLUSIONS
  Endoscopic suturing of FC-SEMSs for benign esophageal disease reduces CSSM compared with unsecured FC-SEMSs but not PC-SEMSs. Patients with previous stent migration may benefit from prophylactic suturing of FC-SEMSs.
authors.affiliation: Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Bick
authors.affiliation: Department of Gastroenterology and Hepatology and Regenstrief Institute, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
authors.affiliation: Department of Biostatistics, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Johnson
authors.affiliation: Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: DeWitt
mesh_terms: D000328:Adult; D000368:Aged; D016099:Endoscopy, Gastrointestinal; D004940:Esophageal Stenosis / Q000628:therapy; D005260:Female; D005548:Foreign-Body Migration / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000209:etiology*; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects*; D013536:Suture Techniques