A simplified strategy for stent fixation using a defect-closure system in refractory esophageal stricture

Abstract

Figures

Tacks were advanced through the stent mesh into the healthy apposing esophageal tissue.

Full text

Refractory esophageal strictures due to benign conditions (such as post-radiation therapy, endoscopic resection, or caustic ingestion) are often managed with endoscopic stenting. Despite its effectiveness, stent migration remains a major limitation, with studies reporting rates of up to 40% 1 . To address this, stent fixation strategies have been developed 2 . An X-Tack defect closure system (Boston Scientific, Marlborough, MA, USA), originally designed for closure of gastrointestinal defects, has also been used for stent anchoring 3 4 . Conventionally, the device utilizes four helical tacks, a running suture, and a cinch. We describe a simplified approach using tack-only fixation, omitting the suture to make the procedure more straightforward.

A 19-year-old patient with caustic-induced esophageal strictures, refractory to multiple dilations, underwent placement of a fully covered stent. Unfortunately, the stent migrated after 2 days and was removed. A second stent was placed and secured using the X-Tack system. After confirming correct positioning by free contrast flow into the stomach, the polypropylene suture was cut and each tack was loaded individually onto the tack-driver catheter. The first tack was advanced through the stent mesh into healthy apposing esophageal tissues ( Fig. 1 ). Secure fixation was verified by the gentle traction of the device prior to release. Additional tacks were deployed in distinct areas along the proximal stent edge, ensuring stable anchorage ( Video 1 ).

Tacks were advanced through the stent mesh into the healthy apposing esophageal tissue.

A simplified tack-only approach was adopted for stent fixation in a caustic-induced esophageal stricture. Tack placement along the proximal stent edge achieved secure and stable anchoring.Video 1

Four weeks later, the stent was removed, with endoscopy showing significant improvement of the stricture. The patient has since tolerated a soft diet without further intervention.

This tack-only fixation technique stabilized the stent effectively, prevented migration and simplified the procedure. By eliminating the suture component, the method offers a user-friendly and reproducible approach, potentially extending the use of the X-Tack system even to endoscopists less familiar with defect closure applications.

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