Complete Esophageal Stenting With Stent Anchoring: A Case Report and Video Presidential Poster

Abstract

FigureIntroduction: Esophageal stents are commonly used for palliation of malignant dysphagia. Novel through the scope stents enable precise placement without fluoroscopy. A new endoscopic suturing device helps anchor esophageal stents, reducing migration risk. We present a case of near total esophageal occlusion due to advanced metastatic esophageal adenocarcinoma managed with multiple esophageal stents anchored proximally with the suturing device. Methods: A 69-year-old male with h/o distal migration of 18 mm x 15 cms fully covered distal esophageal stent and persistent dysphagia despite placement of 18 mm x 7 cms uncovered self-expanding metal stent (SEMS) for metastatic distal esophageal carcinoma was referred to our center for further management. Barium swallow revealed multiple strictures and levels of obstruction in the esophagus starting almost from the UES to the GE junction. Luminal obstruction was due to combination of tumor and radiation stenosis. Patient refused feeding tube placement and expressed a strong desire to be able to eat, especially given his poor prognosis. At EGD, the UES was seen at 20 cms, the proximal stricture was seen at 23cms, allowing just enough room for the proximal stent flange. Multiple areas of severe luminal narrowing were seen throughout the esophagus with evidence of tumor ingrowth into previously placed SEMS. A total of 2 new stents were placed: 18 mm x 10 cms uncovered SEMS distally and a novel “through the scope” partially covered 18 mm x 12 cms SEMS placed proximally. To decrease risk of migration, proximal flange of stent just below the UES was anchored using the suturing device. Results: Esophageal stenting allows for improving nutritional status and quality of life, especially in end stage esophageal cancer. However, it can be technically challenging and has risk of migration and occlusion, as in our patient. The new through the scope stents can reduce technical difficulty and need for fluoroscopy. The new suturing device can help anchor stents to prevent migration. Successful palliation of dysphagia was achieved in our patient without any procedure related complication or patient discomfort. The proximal stent flange was anchored successfully using the suturing device. Conclusion: To our knowledge, this is the first reported case of near total esophageal metal stenting with endoscopic suture anchoring of the proximal stent to successfully palliate malignant dysphagia in a patient with advanced esophageal cancer.