Clinical Outcomes of Fully Covered Biliary Stents With Anti-Migration Fins for the Treatment of Esophageal Strictures

Introduction: Endoscopic placement of metal stents can improve dysphagia and quality of life in patients with symptomatic esophageal strictures. Traditional esophageal stents have large diameters (≥14 mm), which can be poorly tolerated when the stricture is very narrow or located in the cervical esophagus. Fully covered self-expandable metal biliary stents (fc-SEMBS) with anti-migration fins (AMF) have anecdotally been used to reduce these issues. However, data on the off-label use of fc-SEMBS is scarce. Therefore, we aimed to assess the efficacy and safety of fc-SEMBS for esophageal strictures. Methods: We designed a single center retrospective study. We identified all consecutive patients with esophageal strictures receiving fc-SEMBS with AMF between August 2017 and December 2022 at a tertiary care hospital. We evaluated the following outcomes: A) Technical success; B) Clinical success; C) Stricture recurrence; and D) Adverse events. Clinical success was categorized as partial or complete response based on endoscopic stricture resolution at 3 to 6 months. We defined stricture recurrence as need for re-interventions after clinical success. Results: Thirteen patients with esophageal strictures (61.5% males, median age 63 years [interquartile range [IQR] 20]) underwent fc-SEMBS with AMF during the study period. Most strictures were benign (85%), severe (median diameter 5 mm [IQR 3]), refractory to ≥3 dilations (50%), and located in the cervical esophagus (46.1%). Most patients (53.8%) had fc-SEMBS as bridging before placing a larger diameter stent. A total of 22 fc-SEMBS were deployed in the cohort, of which technical success was 100%. Clinical success was 80% (8/10 patients), including 2/10 with complete stricture resolution at 3-6 months, both of whom had stent upsizing. Of those who had clinical success, 62.5% (5/8) had stricture recurrence during follow-up. Data on clinical success was missing in 3/13 patients. Of the deployed stents, 52.6% migrated despite AMF, 13.7% became occluded, and 4.5% caused mucosal trauma that led to removal. Two stents were anchored with clips and still migrated, while none was sutured in place. There was no reported perforation or bleeding. Conclusion: Endoscopic placement of fc-SEMBS with AMF is a feasible treatment modality for complex esophageal strictures, especially when used as a gradual bridge towards a larger diameter esophageal stent. However, the rate of stent migration and occlusion may be higher than traditional esophageal stents.