Feasibility and Safety of Duodenal Covered Self-expandable Metallic Stent Fixation: an Experimental Study

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2019 Feb 14

PMID 30759276

Citations 7

Authors

Yasuki Hori

Kazuki Hayashi

Itaru Naitoh

Hiroyuki Kato

Tatsuma Nomura

Katsuyuki Miyabe

Michihiro Yoshida

Naruomi Jinno

Makoto Natsume

Akihisa Kato

Go Asano

Shuji Takiguchi

Kiyokazu Nakajima

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Migration of duodenal covered self-expandable metallic stents (C-SEMS) is the main cause of stent dysfunction in patients with malignant gastric outlet obstruction. However, the ideal method to prevent migration has not been clarified. We aimed to evaluate the feasibility and safety of duodenal C-SEMS fixation in this experimental study.

Methods: We used the over-the-scope clip (OTSC), suture, and clip methods to fix duodenal C-SEMS and evaluated the gripping force of each device and invasion depth based on pathological findings.

Results: The OTSC and suturing systems had a significantly higher mean gripping force compared with the clipping system (OTSC vs. clip: 13.2 vs. 1.0 Newtons [N], P < 0.001; suture vs. clip: 8.5 vs. 1.0 N, P < 0.001). OTSC compression was stronger compared with suturing (OTSC vs. suture: 13.2 vs. 8.5 N, P = 0.006). The submucosal layer, but not the muscle layer, was compressed more widely and deeply by OTSC compared with clips based on pathological findings by hematoxylin and eosin staining.

Conclusion: Both OTSC and suturing methods used for duodenal C-SEMS fixation were feasible compared with the clipping method. The pathological evaluation of invasion depth indicated that OTSC may be safe even for preventive use. This study suggested that these methods can be applied clinically for duodenal C-SEMS fixation.

Citing Articles

Newly designed OTS Clip for preventing fully-covered self-expandable metal stent migration in the gastrointestinal tract.

Manta R, Del Nero L, Todd B, Parodi A, De Ceglie A, Zito F Endosc Int Open. 2023; 11(3):E284-E287.

PMID: 36968979 PMC: 10038747. DOI: 10.1055/a-2032-4147.

Over-the-Scope-Clips Can Be Fired Safely Over a Guidewire: Proof of Concept in an Ex-Vivo Porcine Model.

DeLong C, Liu A, Winder J, Pauli E JSLS. 2023; 27(1).

PMID: 36818768 PMC: 9913066. DOI: 10.4293/JSLS.2022.00069.

Efficacy of endoscopic over-the-scope clip fixation for preventing migration of self-expandable metal stents: a systematic review and meta-analysis.

Jena A, Chandnani S, Jain S, Sharma V, Rathi P Surg Endosc. 2023; 37(5):3410-3418.

PMID: 36717426 DOI: 10.1007/s00464-023-09893-z.

Efficacy and safety of self-expandable metal stent placement for treatment of primary and metastatic gastric outlet obstruction.

Lai H, Wu K, Liu Y, Li D, Peng T, Zhang B Ir J Med Sci. 2022; 192(5):2077-2084.

PMID: 36441448 DOI: 10.1007/s11845-022-03195-4.

Duodenal stent fixation using through-the-scope helix tack and suture device.

Wilson N, McDonald N, Megna B, Abdallah M, Bilal M Endoscopy. 2022; 55(S 01):E102-E103.

PMID: 36241182 PMC: 9829776. DOI: 10.1055/a-1944-9018.

References

Hori Y, Hayashi K, Yoshida M, Naitoh I, Ban T, Miyabe K . Novel characteristics of traction force in biliary self-expandable metallic stents. Dig Endosc. 2016; 29(3):347-352. DOI: 10.1111/den.12796. View

Seven G, Irani S, Ross A, Gan S, Gluck M, Low D . Partially versus fully covered self-expanding metal stents for benign and malignant esophageal conditions: a single center experience. Surg Endosc. 2013; 27(6):2185-92. DOI: 10.1007/s00464-012-2738-x. View

Hori Y, Naitoh I, Nakazawa T, Hayashi K, Miyabe K, Shimizu S . Feasibility of endoscopic retrograde cholangiopancreatography-related procedures in hemodialysis patients. J Gastroenterol Hepatol. 2013; 29(3):648-52. DOI: 10.1111/jgh.12336. View

Baron T . Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med. 2001; 344(22):1681-7. DOI: 10.1056/NEJM200105313442206. View

Bick B, Imperiale T, Johnson C, DeWitt J . Endoscopic suturing of esophageal fully covered self-expanding metal stents reduces rates of stent migration. Gastrointest Endosc. 2017; 86(6):1015-1021. DOI: 10.1016/j.gie.2017.03.1545. View

Dormann A, Meisner S, Verin N, Wenk Lang A . Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy. 2004; 36(6):543-50. DOI: 10.1055/s-2004-814434. View

Watanabe K, Hikichi T, Nakamura J, Takagi T, Suzuki R, Sugimoto M . Feasibility of esophageal stent fixation with an over-the-scope-clip for malignant esophageal strictures to prevent migration. Endosc Int Open. 2017; 5(11):E1044-E1049. PMC: 5658212. DOI: 10.1055/s-0043-111793. View

Hori Y, Naitoh I, Ban T, Narita K, Nakazawa T, Hayashi K . Stent under-expansion on the procedure day, a predictive factor for poor oral intake after metallic stenting for gastric outlet obstruction. J Gastroenterol Hepatol. 2015; 30(8):1246-51. DOI: 10.1111/jgh.12933. View

Graber I, Dumas R, Filoche B, Boyer J, Coumaros D, Lamouliatte H . The efficacy and safety of duodenal stenting: a prospective multicenter study. Endoscopy. 2007; 39(9):784-7. DOI: 10.1055/s-2007-966594. View

10.

Goto O, Sasaki M, Ishii H, Horii J, Uraoka T, Takeuchi H . A new endoscopic closure method for gastric mucosal defects: feasibility of endoscopic hand suturing in an ex vivo porcine model (with video). Endosc Int Open. 2015; 2(2):E111-6. PMC: 4424863. DOI: 10.1055/s-0034-1377180. View

11.

Dubecz A, Watson T, Raymond D, Jones C, Matousek A, Allen J . Esophageal stenting for malignant and benign disease: 133 cases on a thoracic surgical service. Ann Thorac Surg. 2011; 92(6):2028-32. DOI: 10.1016/j.athoracsur.2011.08.033. View

12.

van Hooft J, Uitdehaag M, Bruno M, Timmer R, Siersema P, Dijkgraaf M . Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study. Gastrointest Endosc. 2009; 69(6):1059-66. DOI: 10.1016/j.gie.2008.07.026. View

13.

von Renteln D, Vassiliou M, Rothstein R . Randomized controlled trial comparing endoscopic clips and over-the-scope clips for closure of natural orifice transluminal endoscopic surgery gastrotomies. Endoscopy. 2009; 41(12):1056-61. DOI: 10.1055/s-0029-1215241. View

14.

Kim C, Choi I, Lee J, Cho S, Park S, Lee J . Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: a randomized, prospective study. Gastrointest Endosc. 2010; 72(1):25-32. DOI: 10.1016/j.gie.2010.01.039. View

15.

Singhal S, Changela K, Papafragkakis H, Anand S, Krishnaiah M, Duddempudi S . Over the scope clip: technique and expanding clinical applications. J Clin Gastroenterol. 2013; 47(9):749-56. DOI: 10.1097/MCG.0b013e318296ecb9. View

16.

Hori Y, Naitoh I, Miyabe K, Yoshida M, Kato A, Jinno N . Simultaneous side-by-side bilateral metal stent placement using a colonoscope in a patient with Billroth II reconstruction. Endoscopy. 2018; 50(8):E218-E219. DOI: 10.1055/a-0624-1947. View

17.

Hori Y, Naitoh I, Hayashi K, Ban T, Natsume M, Okumura F . Predictors of stent dysfunction after self-expandable metal stent placement for malignant gastric outlet obstruction: tumor ingrowth in uncovered stents and migration of covered stents. Surg Endosc. 2017; 31(10):4165-4173. DOI: 10.1007/s00464-017-5471-7. View

18.

Lim S, Kim J, Lee K, Shin S, Kim C, Kim K . Conformable covered versus uncovered self-expandable metallic stents for palliation of malignant gastroduodenal obstruction: a randomized prospective study. Dig Liver Dis. 2014; 46(7):603-8. DOI: 10.1016/j.dld.2014.02.024. View

19.

Hori Y, Naitoh I, Hayashi K, Ban T, Natsume M, Okumura F . Predictors of outcomes in patients undergoing covered and uncovered self-expandable metal stent placement for malignant gastric outlet obstruction: a multicenter study. Gastrointest Endosc. 2016; 85(2):340-348.e1. DOI: 10.1016/j.gie.2016.07.048. View

20.

Sumiyama K, Gostout C, Rajan E, Bakken T, Deters J, Knipschield M . Endoscopic full-thickness closure of large gastric perforations by use of tissue anchors. Gastrointest Endosc. 2006; 65(1):134-9. DOI: 10.1016/j.gie.2006.01.050. View