BACKGROUND: Although safe and effective, a wide array of complications of esophageal stent placement continues to pose a significant challenge to clinicians in providing optimal care for their patients. METHODS: To identify factors associated with migration of self-expandable metal stent (SEMS) used in treating malignant and benign disease of esophagus, a retrospective study analyzing 105 cases (85 patients) of esophageal SEMS placement between January 2013 and June 2015 was conducted. All cases were performed in a single tertiary referral center. The key outcomes of interest were SEMS migration rates based on indication, stent type, design, and endoscopic findings prior to SEMS placement. Technical success rate, other major adverse outcomes and subgroup analysis of interest were also performed. RESULTS: Overall esophageal SEMS migration rate was 26.7%. Significantly higher rates of stent migration were associated with fully covered stent use (38.1% vs 9.5%, P = 0.001) and stent use in benign conditions (43.9% vs 15.6%, P = 0.002). Our multivariable analysis also showed statistically significant increased risk of migration for SEMS placement in distal esophagus (P = 0.006). CONCLUSIONS: This study validated some of previously reported predictors of stent migration. In addition, stent use in benign esophageal disease was found to be a significant risk factor of SEMS migration. Large, prospective studies are necessary to further clarify modifiable risk factors to reduce the rate of SEMS migration.
Constriction, Pathologic ; Deglutition Disorders ; Esophageal Diseases ; Esophagus ; Humans ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Stents* ; Tertiary Care Centers

BACKGROUND/AIMS: Immunoglobulin G4 (IgG4)-associated cholangiopathy (IAC) is an inflammatory disease and may mimic primary sclerosing cholangitis (PSC), cholangiocarcinoma (CCA), or pancreatic cancer on cholangiography. We investigated whether IgG4 levels in bile aspirated during endoscopic retrograde cholangiopancreatography (ERCP) can distinguish IAC from PSC, CCA, and pancreatic cancer. METHODS: Bile was aspirated directly from the common bile duct during ERCP in patients with IAC prior to steroid therapy. For control purposes, bile was obtained from patients with PSC, CCA, pancreatic cancer, and benign biliary conditions (sphincter of oddi dysfunction/choledocholithiasis). RESULTS: Biliary IgG4 levels were measured in 54 patients. The median bile IgG4 levels were markedly elevated in patients with IAC (5.5 mg/dL; interquartile range [IQR], 5.1 to 15.6) as compared to patients with benign biliary conditions (0 mg/dL; IQR, 0 to 0.1; p=0.003). The median biliary IgG4 levels in PSC, CCA, and pancreatic cancer were 1.2 (IQR, 0.2 to 3.8), 0.9 (IQR, 0.2 to 3.4), and 0.2 mg/dL (IQR, 0.1 to 0.8), respectively. A cutoff value of 3.8 mg/dL distinguished IAC from PSC and CCA patients with 100% and 76.9% sensitivity and specificity, respectively. CONCLUSIONS: The results of this pilot study suggest that measurement of biliary IgG4 levels may have clinical value in distinguishing patients with IAC from biliary disorders that can mimic IAC.
Bile* ; Cholangiocarcinoma ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis, Sclerosing ; Common Bile Duct ; Humans ; Immunoglobulin G* ; Immunoglobulins ; Pancreatic Neoplasms ; Pilot Projects* ; Sensitivity and Specificity