Endoscopic suture fixation of self-expanding metallic stents with and without submucosal injection
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- 作者：Victor T. Wilcox ; Albert Y. Huang ; Nabil Tariq ; Brian J. Dunkin
- 关键词：Endoscopic ; Suture fixation ; Stents submucosal ; Injection overstitch
- 刊名：Surgical Endoscopy
- 出版年：2015
- 出版时间：January 2015
- 年：2015
- 卷：29
- 期：1
- 页码：24-29
- 全文大小：1,154 KB
- 参考文献：1. Leenders BJ, Stronkhorst A, Smulders FJ, Nieuwenhuijzen GA, Gilissen LP (2013) Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital. Surg Endosc 27(8):2751-759 CrossRef
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8. Blackmon SH, Santora R, Schwarz P, Barroso A, Dunkin BJ (2010) Utility of removable esophageal covered self-expanding metal stents for leak and fistula management. Ann Thorac Surg 89(3):931-37 CrossRef - 刊物类别：Medicine
- 刊物主题：Medicine & Public Health
Surgery
Gynecology
Gastroenterology
Hepatology
Proctology
Abdominal Surgery - 出版者：Springer New York
- ISSN：1432-2218
文摘
Background Self-expanding metallic stents (SEMS) are useful for treating leaks after bariatric procedures but stent migration (12 to 40?%) remains a problem. Suture fixation has been used to minimize migration but has attendant risks of transmural penetration. We hypothesized that submucosal injection would decrease the risk of full thickness suture penetration while still providing greater pullout forces than endoscopic clipping. Methods Porcine explant models and 155?mm SEMS were used with a force meter to measure the pullout forces required to dislodge the stent. Stents were first deployed without fixation and this pullout force acted as a control. The explants were then randomized to receive fixation with clips, endoscopic suturing with submucosal elevation, or endoscopic suturing without submucosal elevation. The pullout force was again measured and the ratio of the experimental to control pullout forces was used as a measure of the efficacy of the fixation. Results Endoscopic suture fixation after submucosal injection resulted in statistically significant increased pullout force compared to clip fixation (n?=?5; mean force ratio 462?%; 95?% confidence interval [CI] 281-43?%; p?n?=?5; mean force ratio 765?%; 95?% CI 258-32?%; p?n?=?5; mean force ratio 108?%; 95?% CI 56-59?%; p? Conclusions Endoscopic suture fixation of SEMS resulted in a statistically significant increase in pullout force necessary to displace the stents. Submucosal injection prior to suture fixation preserves the increased pullout force while minimizing the risk of transmural penetration with the potential for less risk of injury to mediastinal structures.