Reply to Silva et al.

Silva et al. reported their experience with the use of hemoclips for anchoring the esophageal endoprosthesis. We earlier proposed the use of hemoclips for this purpose in a case of bronchogenic carcinoma with esophagobronchial fistula where there was no compromise of the esophageal lumen [1]. The communication of Silva et al. further augments our argument that clipping provides adequate anchorage for endoprostheses in situations where the risk of migration is high, as described. Their study confirms that the clips provide an initial anchorage to keep the prosthesis in place while the metal wires of the uncovered proximal and distal segments of the stents gradually become embedded within the adjacent tissue. Furthermore, the clips seem to stay in place for a sufficient length of time even where there is no luminal narrowing that would provide prolonged anchorage. The key factor in determining the anchorage is that an adequate amount of the adjacent healthy tissue should be grasped, along with one of the wires of the metal mesh at the proximal end of the stent. It is indeed our policy to deploy one or two clips for anchoring the metal stents ‘prophylactically’ whenever the luminal narrowing appears inadequate for holding the stent in place.

References

• 1 Sriram P V, Das G, Rao G V, Reddy D N. Another novel use of endoscopic clipping: to anchor an esophageal endoprosthesis.  Endoscopy. 2001;  33 724-726