Esophageal covered stent fixation using an endoscopic over-the-scope clip. Mechanical proof of the concept and first clinical experience
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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.
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.
Padlock is faster than endoscopic suturing and achieves similar stent fixation. The first clinical case confirms the feasibility of the method.
KeywordsFully covered self-expandable metal stents Stent, stent migration Stent fixation Aponos clip Overstitch Clips Endoscopic suturing
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.
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 1 (MP4 25741 kb)
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