ELIMINATING

1
ELIMINATING COVERED SELF-EXPANDING STENT
MIGRATION WITH A NOVEL FIXATION PROCEDURE
Calvin Lyons, MD, Min P. Kim, MD, Shanda H.
Blackmon, MD, MPH Division of Thoracic Surgery,
Department of Surgery The Methodist Hospital,
Houston, Texas
Weill Cornell Medical College
TECHNIQUE Endoscopic stent
placement Endoscopic rat tooth forcep
delivery of umbilical tape into center of stent
released Pass rat tooth through
proximal uncovered metal Weave of the stent
and grasp umbilical tape Deliver other end of
umbilical tape out of mouth Re-position
both ends of tape through nares with ET suction
Catheter and tie to prevent distal migration
BACKGROUND Leakage from esophageal and gastric
perforation carries a high morbidity and often
requires surgical intervention. In spite of the
promising early results from esophageal stenting,
migration of the stent continues to plague the
physician, and occurs twenty to sixty percent of
the time. A new technique to prevent migration of
the stent is described. METHODS Ten patients
presenting with leakage from the foregut
underwent stent fixation with a novel technique
in a single institution from January 2008 to
January 2011. RESULTS Five patients who
previously presented with stent migration and
required re-positioning of the stent successfully
had stent fixation with the temporary bridle
technique. An additional five patients who were
at high risk for stent migration had the new
technique used and experienced successful anchor
of the stent. CONCLUSIONS This novel technique
of stent anchoring to prevent migration is both
safe and effective when treating patients with
benign leaks and fistulas of the foregut. Until
non-migrating stents can be developed, such
techniques will be required to prevent additional
complications.
migrated Wallflex into distal jejunum
bridled re-positioned Wallflex w contrast
Bridle is removed after 4 days which is enough
time for tissue ingrowth to occur and
prevent migration Non-FDA-approved removal is
performed within 30 days if for leak
Polyflex is removed and new Wallflex is placed
migrated Polyflex into the stomach
bridled Wallflex
Bridle holding stent
2
ELIMINATING COVERED SELF-EXPANDING STENT
MIGRATION WITH A NOVEL FIXATION PROCEDURE
Calvin Lyons, MD Shanda H. Blackmon, MD,
MPH Division of Thoracic Surgery, Department of
Surgery The Methodist Hospital, Houston, Texas
Weill Cornell Medical College
TECHNIQUE Endoscopic stent
placement Endoscopic rat tooth forcep
delivery of umbilical tape into center of stent
released Pass rat tooth through
proximal uncovered metal Weave of the stent
and grasp umbilical tape Deliver other end of
umbilical tape out of mouth Re-position
both ends of tape through nares and tie to
prevent distal migration
BACKGROUND Leakage from esophageal and gastric
perforation carries a high morbidity and often
requires surgical intervention. In spite of the
promising early results from esophageal stenting,
migration of the stent continues to plague the
physician, and occurs twenty to sixty percent of
the time. A new technique to prevent migration of
the stent is described. METHODS Ten patients
presenting with leakage from the foregut
underwent stent fixation with a novel technique
in a single institution from January 2008 to
January 2011. RESULTS Five patients who
previously presented with stent migration and
required re-positioning of the stent successfully
had stent fixation with the temporary bridle
technique. An additional five patients who were
at high risk for stent migration had the new
technique used and experienced successful anchor
of the stent. CONCLUSIONS This novel technique
of stent anchoring to prevent migration is both
safe and effective when treating patients with
benign leaks and fistulas of the foregut. Until
non-migrating stents can be developed, such
techniques will be required to prevent additional
complications.
migrated Wallflex into distal jejunum
bridled re-positioned Wallflex w contrast
Bridle is removed after 4 days which is enough
time for tissue ingrowth to occur and
prevent migration Non-FDA-approved removal is
performed within 30 days if for leak
Polyflex is removed and new Wallflex is placed
migrated Polyflex into the stomach
bridled Wallflex
Bridle holding stent