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

Date publication

janvier 2015

Auteurs

Membres identifiés du Cancéropôle Est :
Pr MARESCAUX Jacques

Tous les auteurs :
Diana M, Swanstrom LL, Halvax P, Legner A, Liu YY, Alzaga A, D'Urso A, Marescaux J

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/25631112

Résumé

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.

Référence

Surg Endosc. 2015 Jan 29.