Anchor technique to prevent stent migration

Dr. KothariTruptesh H. Kothari MD, MS from the University of Rochester Medical Center in Rochester, New York, USA discusses this VideoGIE case “Anchor technique: prevention of intraluminal stent migration with the help of loop and clips.”

Our video describes one of the various methods to anchor the intraluminal stent from migration. A 50-year-old male with Roux-en-Y gastric bypass developed dysphagia and vomiting 2 months after surgery. At another institution, the patient had placement of an esophageal fully covered stent (23 mm × 105 mm) (Wallflex; Boston Scientific, Natick, Mass), which was secured with a suture device. After 2 weeks, the stent migrated and was removed from the jejunum. After 1 week, the patient presented to us with abdominal pain and vomiting. An upper endoscopy revealed a stricture, confirmed with fluoroscopy. Under fluoroscopic and endoscopic guidance, we deployed a fully covered esophageal stent (Bonastent; Endochoice, Alpharetta, Ga) (18 mm x 60 mm). An Endoloop was then placed around the proximal end, and 3 hemoclips were used to secure the loop to the gastric remnant to help prevent distal migration.

FigureFigure 1. A, Barium study before stent. B, Barium study after stent.

Use of endoloop in endoscopy is limited and its use is wisely demonstrated in this case with success. It is difficult to deploy endoloop around the stent and secure the grip of the stent without closing or narrowing the stent lumen. Also demonstrated in this video is the use of hemostasis clips to anchor the loop.

In such cases, deployment of the endoloop should be from the bottom of the stent so the endoloop has a good grip around the stent. Recently, I tried deploying the endoloop from the upper portion of the stent and it was difficult to loop around the stent due to unstable position.

Find more VideoGIEs available online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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