Migration Rates, Clinical and Technical Success for Fixated Compared to Non-Fixated Fully Covered Esophageal Self-Expandable Metal Stents (FC-SEMS)
Priyaranjan Kata*, Vinay Jahagirdar, Bhanu Siva Mohan Pinnam, Harsh K Patel, Viveksandeep ThoguluvaChandrasekar, Madhav Desai, Prateek Sharma and Abhilash Perisetti
ABSTRACT
Background: Stent migration is a known complication of fully covered self-expandable esophageal metal stents (FC-SEMS), leading to reduced efficacyand repeat endoscopic intervention. Whether fixation reduces migration and improves outcomes in FC-SEMS specifically has not been established.
Methods: PubMed and Embase were searched from inception through June 2025 for studies comparing fixated and non-fixated stents. A random-effectsmodel was used; methodological quality was assessed using a structured scoring system adapted from the Newcastle-Ottawa Scale. Prespecified subgroup analyses were performed for sutured fixation.
Results: Twenty-two studies comprising 2,337 stent placements (1,058 fixated; 1,279 non-fixated) were included. The pooled migration rate was significantly lower with fixation compared with non-fixation (15% vs. 40%; RR 0.49, 95% CI 0.38–0.63; p < 0.01). In the sutured fixation subgroup, the pooled migration rate was 13% (RR 0.49, 95% CI 0.37–0.65; p < 0.01). Technical success was near-universal in both groups, and adverse event rates were comparable (14% vs. 19%; risk ratio 0.86; p = 0.41). Overall fixation showed a non-significant trend toward higher clinical success (62% vs. 45%; RR 1.27, 0.98–1.66; p =0.07); however, sutured fixation significantly improved clinical success compared with non-fixated stents (64% vs. 45%; RR 1.33, 1.05–1.69; p = 0.02).
Conclusions: Endoscopic fixation reduces migration of these stents by approximately 50% without increasing adverse events. Of the fixation methods,sutured fixation improved clinical success by 30% (not observed with overall fixation) and should be routinely considered when FC-SEMS are placed inhigh-risk settings.
