Singer Jordan L, Aryaie Amir H, Fayezizadeh Mojtaba, Lash Jon, Marks Jeffrey M
1 University Hospitals Case Medical Center, Cleveland, OH, USA.
2 Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Surg Innov. 2017 Aug;24(4):353-357. doi: 10.1177/1553350617702026. Epub 2017 Apr 6.
With recent advancements in endoscopy, self-expandable metal stents (SEMS) have been used to treat gastrointestinal leaks, perforations, and strictures. Stent migration frequently complicates management and often requires additional treatments to reach resolution. Our study aimed to determine predictive factors for stent migration.
Consecutive procedures involving SEMS placed with and without fixation after upper gastrointestinal surgery between 2009 and 2014 were retrospectively reviewed. Demographic, surgical history, rate of stent migration, and stent characteristic data were collected. Rates of stent migration were compared.
We reviewed 214 consecutive procedures involving stents placed in the foregut. Median duration of stent placement was 4.0 ± 10.3 weeks. Forty-three (20%) stents migrated after placement. Of those, 27 (63%) required stent replacement. Eleven (5%) procedures utilized stent fixation and 203 (95%) did not. Fixation techniques included endoscopic clips (9%), endoscopic sutures (73%), and transnasal sutures (18%). Stent migration rate was not different between those with and those without fixation ( P = .2). Rate of migration was significantly higher in procedures involving fully covered stents ( P < .001). Migration occurred after esophagectomy and gastric bypass ( P < .001 and P < .05, respectively) and in patients with diabetes ( P < .01).
A challenge with SEMS use is stent migration. Diabetes and using fully covered stents were associated with migration as were SEMS used to treat complications of esophagectomy and gastric bypass. Stent fixation was not associated with the prevention of stent migration. No pattern was found that favors an approach to reduce stent migration.
随着内镜技术的最新进展，自膨式金属支架（SEMS）已被用于治疗胃肠道漏、穿孔和狭窄。支架移位常常使治疗变得复杂，且往往需要额外的治疗才能解决。我们的研究旨在确定支架移位的预测因素。
回顾性分析2009年至2014年间上消化道手术后放置或未放置固定装置的SEMS连续手术病例。收集人口统计学、手术史、支架移位率和支架特征数据。比较支架移位率。
我们回顾了214例连续的前肠支架置入手术。支架置入的中位持续时间为4.0±10.3周。43个（20%）支架置入后发生移位。其中，27个（63%）需要更换支架。11例（5%）手术使用了支架固定，203例（95%）未使用。固定技术包括内镜夹（9%）、内镜缝合（73%）和经鼻缝合（18%）。固定组和未固定组的支架移位率无差异（P = 0.2）。完全覆盖支架的手术中移位率显著更高（P < 0.001）。食管切除术后和胃旁路术后发生移位（分别为P < 0.001和P < 0.05），糖尿病患者也发生移位（P < 0.01）。
使用SEMS的一个挑战是支架移位。糖尿病、使用完全覆盖支架以及用于治疗食管切除术和胃旁路术后并发症的SEMS均与移位有关。支架固定与预防支架移位无关。未发现有利于减少支架移位方法的模式。
