CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(02): E217-E223
DOI: 10.1055/s-0043-125363
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

Fully-covered metal stents with endoscopic suturing vs. partially-covered metal stents for benign upper gastrointestinal diseases: a comparative study

Saowanee Ngamruengphong*
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Reem Sharaiha*
2  Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, United States
,
Amrita Sethi
3  Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, United States
,
Ali Siddiqui
4  Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Christopher J. DiMaio
5  Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Susana Gonzalez
5  Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Jason Rogart
6  Capital Health Center for Digestive Health, Pennington, New Jersey, United States
,
Sophia Jagroop
7  North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, United States
,
Jessica Widmer
7  North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, United States
,
Jennifer Im
5  Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Raza Abbas Hasan
4  Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Sobia Laique
4  Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Tamas Gonda
3  Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, United States
,
John Poneros
3  Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, United States
,
Amit Desai
2  Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, United States
,
Katherine Wong
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Vipin Villgran
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Olaya Brewer Gutierrez
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Majidah Bukhari
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Yen-I Chen
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Ruben Hernaez
8  Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
,
Yuri Hanada
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Omid Sanaei
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Amol Agarwal
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Anthony N. Kalloo
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Vivek Kumbhari
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Vikesh Singh
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Mouen A. Khashab
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
› Author Affiliations
Further Information

Publication History

submitted 26 September 2017

accepted after revision 18 December 2017

Publication Date:
02 February 2018 (online)

Abstract

Background and study aims Self-expandable metallic stents (SEMS) have been increasingly used in benign conditions (e. g. strictures, fistulas, leaks, and perforations). Fully covered SEMS (FSEMS) were introduced to avoid undesirable consequences of partially covered SEMS (PSEMS), but come with higher risk of stent migration. Endoscopic suturing (ES) for stent fixation has been shown to reduce migration of FSEMS. Our aim was to compare the outcomes of FSEMS with ES (FS/ES) versus PSEMS in patients with benign upper gastrointestinal conditions.

Patients and methods We retrospectively identified all patients who underwent stent placement for benign gastrointestinal conditions at seven US tertiary-care centers. Patients were divided into two groups: FSEMS with ES (FS/ES group) and PSEMS (PSEMS group). Clinical outcomes between the two groups were compared.

Results A total of 74 (FS/ES 46, PSEMS 28) patients were included. On multivariable analysis, there was no significant difference in rate of stent migration between FS/ES (43 %) and PSEMS (15 %) (adjusted odds ratio 0.56; 95 % CI 0.15 – 2.00). Clinical success was similar [68 % vs. 64 %; P = 0.81]. Rate of adverse events (AEs) was higher in PSEMS group [13 (46 %) vs. 10 (21 %); P = 0.03). Difficult stent removal was higher in the PSEMS group (n = 5;17 %) vs. 0 % in the FS/ES group; P = 0.005.

Conclusions The proportion of stent migration of FS/ES and PSEMS are similar. Rates of other stent-related AEs were higher in the PSEMS group. PSEMS was associated with tissue ingrowth or overgrowth leading to difficult stent removal, and secondary stricture formation. Thus, FSEMS with ES for stent fixation may be the preferred modality over PSEMS for the treatment of benign upper gastrointestinal conditions.

* These authors contributed equally.