Résumé
Fully covered self-expandable metallic stents (FCSEMS) are recommended for the treatment of esophageal benign issues such as refractory strictures or leaks, perforations and fistulas. The main inconvenient with these stent is the risk of migration, and numbers of fixation techniques have been developed recently with a controversial effectiveness or difficult use in routine practice. The primary objective of this study was to evaluate the efficacy of a new method "double clip-rubber band" (DCRB) by comparing the difference in stent migration between stents fixed by this technique, by through-the-scope clip only or unfixed in procedures involving benign pathologies. Material and methods: we included the patients who benefited from a FCSEMS placement for benign indication between January 2015 and September 2022 in the Montpellier University Hospital. Primary outcome was the comparison of stent migration according to fixation method. Secondary outcomes were clinical, technical, removal success and safety. Univariate and multivariate analysis have also been performed to find migration risk factors. Results: 146 procedures have been included. Migration in the DCRB group was significantly lower than in the clip group and the unfixed group (respectively 8%, 52.1% and 47.9%) in univariate analysis (p<0.001) and multivariate analysis (p=0.003). There was no significant difference for secondary outcomes. Conclusion: DCRB method seems to reduce migration risk for FCSEMS in benign issues, compared to the fixation by clip only or the absence of fixation. These results are promising, but need to be confirmed by a randomized control trial.