Symptomatic gastric strictures or stenosis in the context of post-surgical anatomy can be recalcitrant to conventional endoscopic therapies, with patients often requiring surgical revision. Fully covered self expandable metallic stents (FCSEMS) in conjunction with our ability to secure the stent with endoscopic sutures has opened the door to treat non-malignant gastric stenosis. To assess the technical feasibility, efficacy, tolerability and safety of long term dwell of endoscopically secured FCSEMS in the stomach. A retrospective review of a prospectively collected database (September-2016 to November-2017) was performed to identify consecutive patients who underwent EGD and through the scope FCSEMS insertion in the stomach.The stent was endoscopically secured with four 2-0 Prolene sutures with the use of a full thickness endoscopic suturing system. The suture pattern was as follows: bite using the tissue helix through the gastric wall, bite through the stent, then bite using the tissue helix through the gastric wall. Technical success was defined as successful stent deployment and securing of the stent with sutures. Short term success was defined as resolution symptoms at 1 month. Long term clinical success was defined as resolution or improvement of symptoms 3 months post stent removal. Ten patients (3M, median age of 53(30-81)) were included. The indications for stent insertion and prior failed therapies can be seen in Table 1. All stent insertions and suturing were technically successful (100%). The stents were well tolerated with only 24 hours of mild post-procedural discomfort likely related to the suturing process. Median stent dwell was 243 (126-342) days for those who had their stents removed (6 patients) (Figure 1). Four patients have not yet had their stents removed at the time of data collection. Two patients had stents with tissue ingrowth into the covered stent and one patient had hemi-circumferential ulceration at margins. One patient was treated by the insertion of consecutive long term sutured stents with dwell times of 246, 181 and 34 days consecutively. Three patients experienced stent migration. Patient 1 passed the stent at day 342 per rectum without complication. Patients 2 and 10 did not return for their scheduled follow-up and required surgical resection for stent removal at day 276 and 241, respectively. There was no unanticipated admission due to stent intolerance. All patients had short term success (100%). Long term clinical success was seen in 50% (3/6) of the patients. A FCSEMS, if secured in the stomach, may be safe, tolerable, and effective for long dwell time. Despite aggressively securing with sutures, stents appear to migrate after approximately 6 months and one should remove or exchange the stent at around this time.Table 1–Clinical characteristics of all patients with secured FCSEMS in the stomach.View Large Image Figure ViewerDownload Hi-res image Download (PPT)