ABSTRACT
BACKGROUND AND AIMS: Fully covered self-expandable metal stents (FCSEMSs) are widely used in benign upper gastrointestinal (GI) conditions, but stent migration remains a limitation. An over-the-scope clip (OTSC) device (Ovesco Endoscopy) for stent anchoring has been recently developed. The aim of this study was to evaluate the effect of OTSC fixation on SEMS migration rate. METHODS: A retrospective review of consecutive patients who underwent FCSEMS placement for benign upper GI conditions between 1/2011 and 10/2022 at 16 centers. The primary outcome was rate of stent migration. The secondary outcomes were clinical success and adverse events. RESULTS: A total of 311 (no fixation 122, OTSC 94, endoscopic suturing 95) patients underwent 316 stenting procedures. Compared to the no fixation (NF) group (n=49, 39%), the rate of stent migration was significantly lower in the OTSC (SF) (n=16, 17%, p=0.001) and endoscopic suturing (ES) group (n=23, 24%, p=0.01). The rate of stent migration was not different between the SF and ES groups (p=0.2). On multivariate analysis, SF (OR 0.34, CI 0.17-0.70, p<0.01) and ES (OR 0.46, CI 0.23-0.91, p=0.02) were independently associated with decreased risk of stent migration. Compared to the NF group (n=64, 52%), there was a higher rate of clinical success in the SF (n=64, 68%; p=0.03) and ES group (n=66, 69%; p = 0.02). There was no significant difference in the rate of adverse events between the three groups. CONCLUSION: Stent fixation using OTSC is safe and effective at preventing stent migration and may also result in improved clinical response.
ABSTRACT
BACKGROUND AND AIMS: Patients with sigmoid-type achalasia can be challenging to treat with per-oral endoscopic myotomy (POEM). A short myotomy improves technical success, however outcomes have not previously been evaluated METHODS: This was a multicenter, international, retrospective study of patients who underwent POEM with short (≤ 4 cm) or standard esophageal myotomy. Outcomes included clinical and technical success, procedural adverse events, and reflux rates. RESULTS: A total of 109 patients with sigmoid achalasia (sigmoid = 74, advanced sigmoid = 35) underwent POEM across 13 centers (Short myotomy = 59, standard = 50). Technical success was 100% across both groups. Patients who underwent short myotomy had a significantly shorter mean procedure time (57.7 ± 27.8 vs 83.1 ± 44.7 minutes, p = 0.0005). A total of 6 AEs were recorded in 6 patients (5.5%; 4 mild, 2 moderate); AE rate was not significantly different between short and standard groups. Ninety-eight patients had follow-up data (median = 3.6 months [IQR, 1-14]) months). Clinical success was 94% (short = 93%; standard = 95%, p = 0.70) and did not differ based on achalasia subtype or sigmoid achalasia severity. Twenty-one (22%) patients reported post-POEM reflux and 44% (16/36) had objective evidence of pathologic reflux. Rates of pathologic reflux were significantly increased in the standard vs short group (OR 18.0 [95% CI: 2.0 - 159.0]; p = 0.009). CONCLUSIONS: POEM with short myotomy is effective and safe for the short-term treatment of sigmoid and advanced sigmoid achalasia. Short myotomy may lead to less reflux than standard myotomy.
ABSTRACT
Video 1Over-the-bar peroral endoscopic myotomy for the therapy of cricopharyngeal dysphagia.