Safety and feasibility of esophageal self- expandable metal stent placement without the aid of fluoroscopy

Abstract

Self-expandable metal stents (SEMSs) are used for the management of certain esophageal conditions such as strictures, perforations, and fistulae. These can be placed using fluoroscopic control, endoscopic control, or a combination of both. We evaluated our institutional experience of placing a SEMS using only endoscopy without the aid of fluoroscopy to determine safety and feasibility using this technique. A retrospective review was performed to identify all patients who underwent esophageal SEMS from January 2010 to June 2015. Placement of SEMS was accomplished under direct endoscopic visualization without the aid of fluoroscopy. Esophageal lesion was initially identified during endoscopy and a fully covered SEMS was passed over the guide wire and deployed under direct vision. Misplacement of the SEMS during the procedure that required replacement with another new SEMS was considered as a failed procedure. Other periprocedural complications caused by placement of SEMS were noted. A total of 172 patients underwent 280 procedures for SEMS placement. Mean age was 66 years. The most common indication for SEMS placement was stricture in 248 (88%) procedures. Periprocedure SEMS misplacement occurred in 12 (4%) patients. However, only 8 (3%) patients needed to have a new SEMS placed during the same procedure. A total of 64 (23%) patients had migration of SEMS. There were no other periprocedure complications leading to adverse events. Self-expandable metal stent can be placed accurately and safely under direct endoscopic visualization without the aid of fluoroscopy.

Safety of Esophageal Stent Placement Without Fluoroscopy

“…While retrosternal pain and migration are more common in the short period, complications such as stent occlusion and migration are more common in the long period (12,13). In a study of Saligram et al involving 280 patients, they reported that the rate of chest pain after stent procedure was 3.6% (4). In our study, 3 (8.3%) patients developed retrosternal pain as an acute complication.…”

“…Migration rate is higher in non-metallic stents but lower in metallic stents. However, complications such as perforation and tumor invasion into the stent are more common in metallic stents (3,4). Metallic stents are usually preferred in patients in whom long-term stenting is planned.…”

Clinical efficacy and safety of palliative esophageal stenting without fluoroscopy: a systematic review and meta-analysis

“…Meta-regression analysis, however, is a weak statistic in terms of assessing the predictive effects of a variable to the reported outcome. In 14 of the included studies [24,25,[38][39][40][41][42][43][44][45][46][47][48][49], the esophageal stent was deployed under direct endoscopic view where as a through-thescope (TTS) technique was used in only one study [9]. In two studies [50,51], the esophageal stent was placed over a guidewire and confirmation of accurate positioning was done by post deployment endoscopy.…”

Endoscopic Treatment of Refractory Variceal Bleed

“…3 The ease of placing and removing the stent under direct visualization without the aid of fluoroscopy makes it safer than Minnesota tube. 5 Esophageal stents can have certain risks such as stent migration, which can be up to 30% of cases. This complication usually occurs after few days and the migrated stent is easily retrievable.…”