Fixation of a modified covered esophageal stent: Its clinical usefulness for preventing stent migration

Background and Study Aims: Membrane-covered self-expandable metal stents ar e effective in preventing tu mor ingrowth and stent obstruction in patients with inoperable esophageal cancer, but migration of stents continues to be a major problem. We therefore constructed a modified covered self-expandab le esophageal metal stent capable of being fixed using a silk thread. The s tent was studied prospectively to define its palliative characteristics and whether it is effective in preventing migration. Patients and Methods: Modified covered self-expandable metal stents were pl aced in 17 patients with malignant gastric cardiac cancer involving the eso phagogastric junction, 41 patients with esophageal cancer, and three patien ts with tracheoesophageal fistulas. Clinical and radiographic follow-up exa minations were carried out at regular intervals. Results: Placement of the stent was successful in all patients, with good s ymptomatic relief and no serious stent-related complications such as esopha geal perforation or hemorrhage. Acute stent placement problems, such as inc omplete expansion or acute angulation of the stent, were noted in four pati ents. However, during a mean follow-up period of 7.5 months (range I to 17 months), there was no stent migration. Conclusions: Modified covered self-expandable esophageal metal stents of th is type would be very effective in preventing stent migration, especially i n patients with malignant gastric cardiac cancer extending to the lower eso phagus, those with short-segment esophageal cancer, and those with tracheoe sophageal fistulas.