Anchoring of esophageal stents with through-the-scope suturing devices: Preclinical proof of concept and first clinical cases.

Abstract

Background and study aims

Esophageal refractory benign strictures are challenging to manage. Fully-covered metallic stents (FCSEMS) are swiftly efficient but subject to high migration rates. Because new through-the-scope suturing devices (TTSS) are now available, an alternative to over-the-scope/through-the-scope clips (OTSC/TTSC) or over-the-scope suturing devices (OTSS) can be trialed to anchor FCSEMS and prevent their dislodgement.

Methods

We performed a preclinical comparison on a porcine model of the ability to prevent FCSEMS migration with TTSS, OTSC, and TTSC. Given the promising results, we then performed stent anchoring with TTSS to selected patients with refractory benign strictures. We hereby present these initial procedures and their outcomes.

Results

In preclinical trials, TTSS provided significantly higher resistance to traction than OTSC, TTSC, and no anchoring. We performed eight FCSEMS anchoring with TTSS among six patients, with encouraging technical and clinical outcomes.

Conclusions

This is the first preclinical and clinical description of the benefits of TTSS for FCSEMS anchoring in esophageal refractory benign strictures. Safe and efficient anchoring with TTSS could allow using double-silicon-layered FCSEMS that can be left in place several months for management of refractory benign strictures. This work paves the way for prospective studies assessing FCSEMS anchoring with TTSS.

Keywords

Endoscopy Upper GI Tract - Benign strictures - Dilation, injection, stenting - Malignant strictures

Publication History

Received: 17 April 2025

Accepted after revision: 02 August 2025

Accepted Manuscript online:
01 December 2025

Article published online:
19 December 2025

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