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THE USE OF HEMOCLIPS TO PREVENT RECURRENT METAL STENT MIGRATION IN ESOPHAGEAL CANCER
A Ribeiro, U Beejay, G de la Mora, L Hourigan, G Kandel, P Kortan, G Haber, NE Marcon
St Michael’s Hospital, Centre for Therapeutic Endoscopy and Endoscopic Oncology, University of Toronto, Toronto, Ontario
BACKGROUND: Esophageal stent migration can be a costly complication in the palliation of esophageal malignancy. Recently, we have been using hemoclips applied to the proximal end of metal stents after a first migration to secure it in position.
AIM: To report our experience with the use of hemoclips to prevent esophageal metal stent migration between 1996 to 2000.
METHODS: Retrospective analysis of all patients with primary esophageal cancer who had metal stent migration and in whom hemoclips were used to prevent a second migration.
RESULTS: A total of 11 patients (10M/1F, mean age: 72 yrs) were identified. Ten patients underwent placement of the Ultraflex® covered self-expandable metal stent and in one patient the covered Z-stent®. Esophageal dilation was routinely performed in all patients prior to stent insertion to a mean of 40 French (range 33-45). The mean time for the first migration and the mean follow-up period were respectively: 30 and 71 days. Reposition of the original stent was done in 9 patients and secured in place by hemoclips applied to its proximal end. Two patients required insertion of a second new stent fixed in place with hemoclips. Ten patients (91%) had no further migration on follow-up. The mean number of hemoclips used and the mean number of upper endoscopies performed on each patient after original stent insertion were respectively: 5 (range: 2-8) and 3 (range: 2-5).
CONCLUSIONS: After the first stent migration, placement of hemoclips to the proximal end is very effective in preventing a second stent migration (91%). Reposition of the original stent with the use of hemoclips to secure it in position may be the most cost effective strategy. Future studies will be needed to determine if “prophylactic” hemoclips should be placed routinely in selected group of patients at risk to develop stent migration.