Gastrointestinal: Utilization of a novel dedicated stent fixation clip device ("stentfix OTSC") for an umbrella-type cardia stent

Abstract

Palliative self-expanding metal stent has become commonplace in clinical endoscopy in patients with metastatic esophageal cancer and/or poor functional status, precluding tumor-specific treatment options. While the endoscopic procedure is generally considered safe, short- and long-term efficacy is threatened, e.g., by stent migration. In recent years, data are accumulating suggesting that clip fixation, e.g. on the over-the-scope-clip (OTSC) platform, may reduce this specific complication and may, thus, become a new routine in gastrointestinal stent treatment. To this end, a novel specific clip fixation device (stentfix OTSC, Ovesco Endoscopy AG, Tübingen, Germany) has been introduced with a distinct clip design with indentations in the application cap and clip brackets bowed to the outside to better engage stent ends (Fig. 1a) This is the clinical case of a 96-year-old female patient with a 60 mm malignant distal esophageal stenosis with the main tumor mass at the cardia itself. Histopathology confirmed an adenocarcinoma of the esophagogastric junction (AEG, Siewert type 1). We chose a partially covered umbrella-type cardia self-expanding metal stent (100 × 24 mm, Leufen, Berlin, Germany). After conventional placement, the stentfix OTSC was applied to the proximal stent rim (Fig. 1b), and retroflexed endoscopic view within a large hiatal hernia confirmed optimal stent position by endoscopy (Fig. 1c) and fluoroscopy (Fig. 1d).