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Surgical Endoscopy

, Volume 29, Issue 11, pp 3367–3372 | Cite as

Esophageal covered stent fixation using an endoscopic over-the-scope clip. Mechanical proof of the concept and first clinical experience

  • Michele DianaEmail author
  • Lee L. Swanström
  • Peter Halvax
  • Andras Lègner
  • Yu-Yin Liu
  • Amilcar Alzaga
  • Antonio D’Urso
  • Jacques Marescaux
Dynamic Manuscript

Abstract

Background and study aims

Endoscopic suturing reduces stent migration, but is challenging and time-consuming. We compare endoscopic suturing versus anchoring with a novel over-the-scope clip (Padlock) to fix esophageal stents. Additionally, the first clinical case of Padlock stent fixation is reported.

Materials and methods

A fully covered esophageal stent was placed in 11 pigs and fixed with one figure-of-eight suture (n = 5) or with a Padlock (n = 4) or not fixed (controls; n = 2). The force required to mobilize the stent was recorded. Clinical case: an esophageal stent was fixed with a Padlock and endoscopically removed 1 month later, in an 82-year-old patient.

Results

Mean force (newton) to mobilize the stent was similar after suturing and Padlock fixation (23.99 ± 14.91 vs. 19.97 ± 7.62; p = 0.32). In controls was 7 and 11 Newtons. Suturing time (seconds) was longer than Padlock application (455.4 ± 144.83 vs. 155 ± 12.9; p = 0.002). Clinical case: stent fixation was feasible and uncomplicated. Removal was easy, and only mild bleeding occurred.

Conclusions

Padlock is faster than endoscopic suturing and achieves similar stent fixation. The first clinical case confirms the feasibility of the method.

Keywords

Fully covered self-expandable metal stents Stent, stent migration Stent fixation Aponos clip Overstitch Clips Endoscopic suturing 

Notes

Acknowledgments

Authors are grateful to Boston Scientific, Apollo Endosurgery and to Aponos Medical for kindly providing the material used in this study. Boston Scientific, Apollo Endosurgery and Aponos Medical had no involvement in data collection or the writing of the manuscript. Furthermore, authors would like to thank Christopher Burel, professional in Medical English proofreading, for his valuable assistance.

Disclosures

Jacques Marescaux is recipient of Grants from Karl Storz, Covidien and Siemens. Lee Swanström has performed consulting services for Aponos Medical. Remaining authors have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MP4 25741 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Michele Diana
    • 1
    • 2
    Email author
  • Lee L. Swanström
    • 2
    • 3
  • Peter Halvax
    • 2
  • Andras Lègner
    • 2
  • Yu-Yin Liu
    • 1
  • Amilcar Alzaga
    • 2
  • Antonio D’Urso
    • 3
  • Jacques Marescaux
    • 1
    • 2
    • 3
  1. 1.IRCAD, Research Institute Against Cancer of Digestive SystemStrasbourgFrance
  2. 2.IHU-StrasbourgUniversity Institute for Minimally-Invasive Hybrid Image-Guided TherapiesStrasbourgFrance
  3. 3.Department of General, Digestive and Endocrine SurgeryUniversity Hospital of StrasbourgStrasbourgFrance

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