P2292 - Comparing Endoscopic Suture vs Over-the-Scope Clips vs No Intervention in Preventing Esophageal Stent Migration: A Network Meta-Analysis

Award: Presidential Poster Award

Manesh Kumar Gangwani, MD¹, Hossein Haghbin, MD², Zohaib Ahmed, MD³, Abeer Aziz, MD⁴, Muhammad Aziz, MD¹, Wade M.. Lee-Smith, MLS¹, Dushyant Singh. Dahiya, MD⁵, Yusuf Nawras, ¹, Faisal Kamal, MD⁶, Sumant Inamdar, MD⁷, Yaseen Alastal, MD¹, Douglas G. Adler, MD^8
1University of Toledo, Toledo, OH; ²Ascension Providence Hospital, Southfield, MI; ³University of Toledo Health Sciences Center, Toledo, OH; ⁴University of Augusta, Augusta, GA; ⁵University of Kansas School of Medicine, Kansas City, KS; ⁶Thomas Jefferson Health, Philadephia, PA; ⁷University of Arkansas, Toledo, OH; ⁸Center for Advanced Therapeutic (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO

Introduction: Stent migration is a commonly encountered and consequential complication associated with the placement of esophageal stents. We aimed to compare stent migration prevention strategy using network meta-analysis comparing endoscopic suture vs OTSC clips vs no intervention to determine optimal strategy.

Methods: Literature search was performed using MEDLINE, Embase, Cochrane, Web of Science, and Global Index Medicus databases. A direct head-to-head comparator analysis and network meta-analysis of all available groups were performed. A comparison of interventions for network meta-analysis was conducted using network meta-analysis using the random-effects model on the ‘R’ package ‘Netmeta’. A p-value < 0.05 was considered statistically significant. The frequentist method was used to rank the intervention and a P-score was generated.

Results: 10 studies with 1019 participants were included in the final analysis. The age of participants ranged from 58.5 - 69.5 years, with males accounting for 59.2%. The direct meta-analysis revealed no statistical difference in migration rates between endoscopic suturing and clips (OR: 1.07, 95% CI: 0.07-14.8, p = 0.96), while both interventions showed lower migration rates than no intervention. The network analysis results were consistent, with no significant difference between suturing and clips (OR: 0.91, 95% CI: 0.24-3.41, p = 0.89). Endoscopic suturing demonstrated a significantly lower migration rate than no intervention (OR: 0.32, 95% CI: 0.17-0.63, p < 0.001), while no significant difference was observed between clips and no intervention (OR: 0.35, 95% CI: 0.10-1.00, p = 0.010). The results appear to favor clips compared to no intervention however statistical significance is not reached. The ranking of intervention favors endoscopic suturing followed by clip and no intervention in preventing stent migration.

Discussion: This study represents the first direct comparator analysis conducting direct and network meta-analyses to assess the rates of esophageal stent migration concerning endoscopic clips, suturing, and no intervention. Our findings indicate that stent fixation with sutures significantly prevents stent migration, with some advantages of endoscopic suture fixation over OTSC. However, it is essential to acknowledge that the feasibility of implementing endoscopic suture fixation in every case is constrained by cost, time, and technical expertise.



Disclosures:


Manesh Kumar Gangwani, MD¹, Hossein Haghbin, MD², Zohaib Ahmed, MD³, Abeer Aziz, MD⁴, Muhammad Aziz, MD¹, Wade M.. Lee-Smith, MLS¹, Dushyant Singh. Dahiya, MD⁵, Yusuf Nawras, ¹, Faisal Kamal, MD⁶, Sumant Inamdar, MD⁷, Yaseen Alastal, MD¹, Douglas G. Adler, MD⁸. P2292 - Comparing Endoscopic Suture vs Over-the-Scope Clips vs No Intervention in Preventing Esophageal Stent Migration: A Network Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.