# Anchoring of esophageal stents with through-the-scope suturing devices: Preclinical proof of concept and first clinical cases

## TL;DR

This paper introduces a new method using through-the-scope suturing devices to anchor esophageal stents, showing promise in preventing stent migration in preclinical and initial clinical cases.

## Contribution

The study is the first to demonstrate the use of TTSS for anchoring FCSEMS in esophageal strictures, offering a novel alternative to existing methods.

## Key findings

- TTSS provided significantly higher resistance to traction than OTSC and TTSC in preclinical trials.
- Eight FCSEMS anchoring procedures with TTSS were performed in six patients with encouraging outcomes.
- TTSS anchoring could enable the use of double-silicon-layered FCSEMS for long-term management of refractory benign strictures.

## Abstract

Esophageal refractory benign strictures are challenging to manage. Fully-covered metallic stents (FCSEMS) are swiftly efficient but subject to high migration rates. Because new through-the-scope suturing devices (TTSS) are now available, an alternative to over-the-scope/through-the-scope clips (OTSC/TTSC) or over-the-scope suturing devices (OTSS) can be trialed to anchor FCSEMS and prevent their dislodgement.

We performed a preclinical comparison on a porcine model of the ability to prevent FCSEMS migration with TTSS, OTSC, and TTSC. Given the promising results, we then performed stent anchoring with TTSS to selected patients with refractory benign strictures. We hereby present these initial procedures and their outcomes.

In preclinical trials, TTSS provided significantly higher resistance to traction than OTSC, TTSC, and no anchoring. We performed eight FCSEMS anchoring with TTSS among six patients, with encouraging technical and clinical outcomes.

This is the first preclinical and clinical description of the benefits of TTSS for FCSEMS anchoring in esophageal refractory benign strictures. Safe and efficient anchoring with TTSS could allow using double-silicon-layered FCSEMS that can be left in place several months for management of refractory benign strictures. This work paves the way for prospective studies assessing FCSEMS anchoring with TTSS.