Anchoring fins of fully covered self-expandable metal stents affect pull-out force and stent migration
Stent migration and subsequent adverse events are frequently observed in the use of fully covered self-expandable metal stents (FCSEMSs) for distal biliary stenosis. In this study, we identified predictors for stent migration based on biomechanical stent characteristics and associated these findings...
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| Veröffentlicht in: | Gastrointestinal endoscopy 2024-03, Vol.99 (3), p.377-386.e3 |
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| creator | Brinkmann, Franz Uhlig, Kai Sambale, Anna Stommel, Markus Berning, Marco Babatz, Jana Sulk, Stefan Krasz, Susanne Schmelz, Renate Brückner, Stefan Hampe, Jochen Zeissig, Sebastian |
| description | Stent migration and subsequent adverse events are frequently observed in the use of fully covered self-expandable metal stents (FCSEMSs) for distal biliary stenosis. In this study, we identified predictors for stent migration based on biomechanical stent characteristics and associated these findings with clinical outcomes.
The migration resistance of FCSEMSs was quantified by measuring the pull-out force. We analyzed a single-center retrospective cohort of 178 FCSEMSs for treatment success and adverse events occurring during 180 days of follow-up.
Biomechanical measurements revealed a 4-fold higher migration resistance of FCSEMSs with anchoring fins (AF-FCSEMSs; Fmax = 14.2 ± .1 N) compared with FCSEMSs with flared ends (FE-FCSEMSs; Fmax = 3.8 ± 1.0 N; P < .0001). Clinically, AF-FCSEMSs showed lower rates of migration compared with FE-FCSEMSs (5% vs 34%, P < .0001). Unscheduled ERCP procedures because of stent dysfunction were less frequent in the AF group compared with the FE group (15% vs 29%, P = .046). Cholangitis because of stent dysfunction was observed in 5% of the AF group compared with 19% in the FE group (P = .02). Stent patency rates at 1, 3, and 6 months were higher in the AF group (96%, 90%, and 80%, respectively) compared with the FE group (90%, 74%, and 66%; log-rank test: P = .03).
The pull-out force as a biomechanical stent property predicts the migration resistance of FCSEMSs in distal biliary stenosis and may thus be used to classify stents for this application. AF-FCSEMSs showed a significantly lower rate of migration and adverse events compared with FE-FCSEMSs.
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| doi_str_mv | 10.1016/j.gie.2023.10.036 |
| format | Article |
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The migration resistance of FCSEMSs was quantified by measuring the pull-out force. We analyzed a single-center retrospective cohort of 178 FCSEMSs for treatment success and adverse events occurring during 180 days of follow-up.
Biomechanical measurements revealed a 4-fold higher migration resistance of FCSEMSs with anchoring fins (AF-FCSEMSs; Fmax = 14.2 ± .1 N) compared with FCSEMSs with flared ends (FE-FCSEMSs; Fmax = 3.8 ± 1.0 N; P < .0001). Clinically, AF-FCSEMSs showed lower rates of migration compared with FE-FCSEMSs (5% vs 34%, P < .0001). Unscheduled ERCP procedures because of stent dysfunction were less frequent in the AF group compared with the FE group (15% vs 29%, P = .046). Cholangitis because of stent dysfunction was observed in 5% of the AF group compared with 19% in the FE group (P = .02). Stent patency rates at 1, 3, and 6 months were higher in the AF group (96%, 90%, and 80%, respectively) compared with the FE group (90%, 74%, and 66%; log-rank test: P = .03).
The pull-out force as a biomechanical stent property predicts the migration resistance of FCSEMSs in distal biliary stenosis and may thus be used to classify stents for this application. AF-FCSEMSs showed a significantly lower rate of migration and adverse events compared with FE-FCSEMSs.
[Display omitted]</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1016/j.gie.2023.10.036</identifier><identifier>PMID: 37863243</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Cholestasis - etiology ; Cholestasis - surgery ; Constriction, Pathologic - etiology ; Humans ; Retrospective Studies ; Self Expandable Metallic Stents - adverse effects ; Stents - adverse effects ; Treatment Outcome</subject><ispartof>Gastrointestinal endoscopy, 2024-03, Vol.99 (3), p.377-386.e3</ispartof><rights>2024</rights><rights>Copyright © 2024. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c305t-a2f168776692e53eab1ab9dc2109033e5731b340aa99e0fa065132d282bcd43f3</cites><orcidid>0000-0002-3474-3115</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0016510723029760$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37863243$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brinkmann, Franz</creatorcontrib><creatorcontrib>Uhlig, Kai</creatorcontrib><creatorcontrib>Sambale, Anna</creatorcontrib><creatorcontrib>Stommel, Markus</creatorcontrib><creatorcontrib>Berning, Marco</creatorcontrib><creatorcontrib>Babatz, Jana</creatorcontrib><creatorcontrib>Sulk, Stefan</creatorcontrib><creatorcontrib>Krasz, Susanne</creatorcontrib><creatorcontrib>Schmelz, Renate</creatorcontrib><creatorcontrib>Brückner, Stefan</creatorcontrib><creatorcontrib>Hampe, Jochen</creatorcontrib><creatorcontrib>Zeissig, Sebastian</creatorcontrib><title>Anchoring fins of fully covered self-expandable metal stents affect pull-out force and stent migration</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>Stent migration and subsequent adverse events are frequently observed in the use of fully covered self-expandable metal stents (FCSEMSs) for distal biliary stenosis. In this study, we identified predictors for stent migration based on biomechanical stent characteristics and associated these findings with clinical outcomes.
The migration resistance of FCSEMSs was quantified by measuring the pull-out force. We analyzed a single-center retrospective cohort of 178 FCSEMSs for treatment success and adverse events occurring during 180 days of follow-up.
Biomechanical measurements revealed a 4-fold higher migration resistance of FCSEMSs with anchoring fins (AF-FCSEMSs; Fmax = 14.2 ± .1 N) compared with FCSEMSs with flared ends (FE-FCSEMSs; Fmax = 3.8 ± 1.0 N; P < .0001). Clinically, AF-FCSEMSs showed lower rates of migration compared with FE-FCSEMSs (5% vs 34%, P < .0001). Unscheduled ERCP procedures because of stent dysfunction were less frequent in the AF group compared with the FE group (15% vs 29%, P = .046). Cholangitis because of stent dysfunction was observed in 5% of the AF group compared with 19% in the FE group (P = .02). Stent patency rates at 1, 3, and 6 months were higher in the AF group (96%, 90%, and 80%, respectively) compared with the FE group (90%, 74%, and 66%; log-rank test: P = .03).
The pull-out force as a biomechanical stent property predicts the migration resistance of FCSEMSs in distal biliary stenosis and may thus be used to classify stents for this application. AF-FCSEMSs showed a significantly lower rate of migration and adverse events compared with FE-FCSEMSs.
[Display omitted]</description><subject>Cholestasis - etiology</subject><subject>Cholestasis - surgery</subject><subject>Constriction, Pathologic - etiology</subject><subject>Humans</subject><subject>Retrospective Studies</subject><subject>Self Expandable Metallic Stents - adverse effects</subject><subject>Stents - adverse effects</subject><subject>Treatment Outcome</subject><issn>0016-5107</issn><issn>1097-6779</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1LxDAQhoMoun78AC-So5euk6RNWzwt4hcseNFzSNPJmqVt1qRd9N-bZdWjp2GG531hHkIuGcwZMHmznq8czjlwkfY5CHlAZgzqMpNlWR-SGSQoKxiUJ-Q0xjUAVFywY3IiykoKnosZsYvBvPvghhW1bojUW2qnrvuixm8xYEsjdjbDz40eWt10SHscdUfjiMMYqbYWzUg3KZH5aaTWB4M0oXuA9m4V9Oj8cE6OrO4iXvzMM_L2cP9695QtXx6f7xbLzAgoxkxzy2RVllLWHAuBumG6qVvD01cgBBalYI3IQeu6RrAaZMEEb3nFG9Pmwoozcr3v3QT_MWEcVe-iwa7TA_opKl5VwIDLXCSU7VETfIwBrdoE1-vwpRionV61Vkmv2undnZLelLn6qZ-aHtu_xK_PBNzuAUxPbh0GFY3DwWDrQjKlWu_-qf8GB0mLNA</recordid><startdate>202403</startdate><enddate>202403</enddate><creator>Brinkmann, Franz</creator><creator>Uhlig, Kai</creator><creator>Sambale, Anna</creator><creator>Stommel, Markus</creator><creator>Berning, Marco</creator><creator>Babatz, Jana</creator><creator>Sulk, Stefan</creator><creator>Krasz, Susanne</creator><creator>Schmelz, Renate</creator><creator>Brückner, Stefan</creator><creator>Hampe, Jochen</creator><creator>Zeissig, Sebastian</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3474-3115</orcidid></search><sort><creationdate>202403</creationdate><title>Anchoring fins of fully covered self-expandable metal stents affect pull-out force and stent migration</title><author>Brinkmann, Franz ; Uhlig, Kai ; Sambale, Anna ; Stommel, Markus ; Berning, Marco ; Babatz, Jana ; Sulk, Stefan ; Krasz, Susanne ; Schmelz, Renate ; Brückner, Stefan ; Hampe, Jochen ; Zeissig, Sebastian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-a2f168776692e53eab1ab9dc2109033e5731b340aa99e0fa065132d282bcd43f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Cholestasis - etiology</topic><topic>Cholestasis - surgery</topic><topic>Constriction, Pathologic - etiology</topic><topic>Humans</topic><topic>Retrospective Studies</topic><topic>Self Expandable Metallic Stents - adverse effects</topic><topic>Stents - adverse effects</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brinkmann, Franz</creatorcontrib><creatorcontrib>Uhlig, Kai</creatorcontrib><creatorcontrib>Sambale, Anna</creatorcontrib><creatorcontrib>Stommel, Markus</creatorcontrib><creatorcontrib>Berning, Marco</creatorcontrib><creatorcontrib>Babatz, Jana</creatorcontrib><creatorcontrib>Sulk, Stefan</creatorcontrib><creatorcontrib>Krasz, Susanne</creatorcontrib><creatorcontrib>Schmelz, Renate</creatorcontrib><creatorcontrib>Brückner, Stefan</creatorcontrib><creatorcontrib>Hampe, Jochen</creatorcontrib><creatorcontrib>Zeissig, Sebastian</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastrointestinal endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brinkmann, Franz</au><au>Uhlig, Kai</au><au>Sambale, Anna</au><au>Stommel, Markus</au><au>Berning, Marco</au><au>Babatz, Jana</au><au>Sulk, Stefan</au><au>Krasz, Susanne</au><au>Schmelz, Renate</au><au>Brückner, Stefan</au><au>Hampe, Jochen</au><au>Zeissig, Sebastian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Anchoring fins of fully covered self-expandable metal stents affect pull-out force and stent migration</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>2024-03</date><risdate>2024</risdate><volume>99</volume><issue>3</issue><spage>377</spage><epage>386.e3</epage><pages>377-386.e3</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><abstract>Stent migration and subsequent adverse events are frequently observed in the use of fully covered self-expandable metal stents (FCSEMSs) for distal biliary stenosis. In this study, we identified predictors for stent migration based on biomechanical stent characteristics and associated these findings with clinical outcomes.
The migration resistance of FCSEMSs was quantified by measuring the pull-out force. We analyzed a single-center retrospective cohort of 178 FCSEMSs for treatment success and adverse events occurring during 180 days of follow-up.
Biomechanical measurements revealed a 4-fold higher migration resistance of FCSEMSs with anchoring fins (AF-FCSEMSs; Fmax = 14.2 ± .1 N) compared with FCSEMSs with flared ends (FE-FCSEMSs; Fmax = 3.8 ± 1.0 N; P < .0001). Clinically, AF-FCSEMSs showed lower rates of migration compared with FE-FCSEMSs (5% vs 34%, P < .0001). Unscheduled ERCP procedures because of stent dysfunction were less frequent in the AF group compared with the FE group (15% vs 29%, P = .046). Cholangitis because of stent dysfunction was observed in 5% of the AF group compared with 19% in the FE group (P = .02). Stent patency rates at 1, 3, and 6 months were higher in the AF group (96%, 90%, and 80%, respectively) compared with the FE group (90%, 74%, and 66%; log-rank test: P = .03).
The pull-out force as a biomechanical stent property predicts the migration resistance of FCSEMSs in distal biliary stenosis and may thus be used to classify stents for this application. AF-FCSEMSs showed a significantly lower rate of migration and adverse events compared with FE-FCSEMSs.
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| ispartof | Gastrointestinal endoscopy, 2024-03, Vol.99 (3), p.377-386.e3 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Cholestasis - etiology Cholestasis - surgery Constriction, Pathologic - etiology Humans Retrospective Studies Self Expandable Metallic Stents - adverse effects Stents - adverse effects Treatment Outcome |
| title | Anchoring fins of fully covered self-expandable metal stents affect pull-out force and stent migration |
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