Anchoring Fins Appear to Reduce Fully Covered Self-Expanding Metal Stent Migration Rates

Pancreatobiliary

Rajesh N. Keswani, MD, MS reviewing Brinkmann F, et al. Gastrointest Endosc 2023 Oct 18.

Fully covered self-expanding metal stents (FCSEMS) are placed for a variety of indications, including palliation of extrahepatic malignant bile duct obstruction, treatment of benign biliary strictures, management of postsphincterotomy perforations, and treatment of postsphincterotomy bleeding. The unique major adverse event of these stents is an increased risk of stent migration. Multiple types of FCSEMS are available, but the impact of stent design choice on migration risk is unknown. This retrospective study compared the risk of migration with the more common stent design of flared ends (FE) versus anchoring fins (AF).

In this single-center retrospective study of 178 FCSEMS placements (80 with AF and 98 with FE), the authors found that the rate for complete distal stent migration (completely out of the bile duct) was significantly lower with FCSEMS using AF compared with FE (3% vs 16%, respectively). Similarly, the rate for proximal stent migration (toward the liver) was significantly lower with AF than with FE (1% vs 12%, respectively). Multivariate analysis found that only the type of stent design was a significant predictor of migration. Using FCSEMS with FE versus AF was also more likely to result in repeat unscheduled ERCP (29% vs 15%) and cholangitis (19% vs 5%).

The authors augmented their findings with some ex vivo testing on the amount of force required to remove an FCSEMS with AF compared with FE. They found that FCSEMS with AF had a 4-fold higher mechanical migration resistance.

Comment:

Understanding that there are major limitations of a single-center retrospective study, this provocative study strongly suggests that endoscopists, when determining that FCSEMS placement is appropriate, should use a stent design with AF to reduce adverse event rates. Until a prospective, multicenter study is available, I suggest the use of FCSEMS with AF to reduce stent migration, given there are no clear downsides to this stent design.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Rajesh N. Keswani, MD, MS

Bio and Disclosures

Citation(s):

Brinkmann F, Uhlig K, Sambale A, et al. Anchoring fins of fully covered self-expanding metal stents affect pull-out force and stent migration. Gastrointest Endosc 2023 Oct 18. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2023.10.036)