Esophageal self-expanding metal stent (SEMS) insertion as the mainstay palliative treatment for advanced malignancy is safe with high reported technical success rates. However, its long-term technical and clinical efficacy might be questioned, given high rates of migration, e.g. when using fully and/or partially covered SEMS designs as first-line options. Against this background, techniques of stent anchoring have evolved in recent years; however, dedicated endoscopic accessory technology has not been available so far. The recently marketed and FDA-approved stentfixOTSC as an innovative iteration of the over-the-scope-clip (OTSC) platform (stentfix OTSC, Ovesco Endoscopy AG, Tübingen, Germany) closes this technological gap [1]. Because of its ease of application, the use of the OTSC has become widely disseminated, with most interventional endoscopists being well trained and acquainted with the OTSC technology. Thus, this specifically designed anchoring device, which has a distinct clip design with indentations in the application cap and clip brackets bowed to the outside to better engage stent ends, may become a novel endoscopic standard-of-care, although rigorous systematic study of its technical and clinical efficacy in the short and long term is clearly needed.
The use of the anchoring device is illustrated in this case of a 91-year-old male who presented with dysphagia due to distal esophageal adenocarcinoma (Fig. 1A). An uncomplicated stent deployment was performed using a 100×24 mm partially covered SEMS with ancillary stentfixOTSC anchoring of the proximal stent struts (Fig. 1 B,C). For comparison purposes, Fig. 1D shows a biodegradable stent being fixed by a conventional OTSC system.
Figure 1 (A) Malignant distal esophageal stricture due to adenocarcinoma prior to stent implantation using a partially covered self-expanding metal stent. (B) Endoscopic and (C) fluoroscopic demonstration of technical success in stentfixOTSC application to proximal stent struts. (D) Juxtaposed illustration of a conventional OTSC system fixed to the proximal parts of a biodegradable stent for refractory benign esophageal stricture (note differentially bowed clip brackets compared to B)
OTSC, over-the-scope clip