https://doi.org/10.1177/1553350617702026 Surgical Innovation 1–5 © The Author(s) 2017 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1553350617702026 journals.sagepub.com/home/sri Original Article Introduction With recent advancements in endoscopy, the use of self- expanding metal stents (SEMS) has been gaining popularity as a minimally invasive treatment of gastrointestinal (GI) leaks and strictures from both benign and malignant disease as well as due to surgical complications. 1-7 Recent evidence has shown that stents can be used as safe alternatives to sur- gery in the management of GI diseases. SEMS can be used to treat perforations by providing a barrier between intra- and extraluminal contents while the defect closes naturally, or they can be used in the management of strictures by func- tioning as a constant dilator of the stenotic region. 8,9 The management of GI diseases with endoscopic stents has been troubled by complications including tis- sue ingrowth, mucosal erosion, and endoscopic compli- cations associated with both placement and removal such as perforation; however, the most common has been stent migration. 9-13 Stent migration rates range from 3.7% to 50% depend- ing on the stent’s diameter, the covering, location of insertion, and material used to make the stent. 14-17 Migration has been associated with significant morbidity and complications, including failure to resolve the leak or stricture and the need for subsequent procedures, such as surgical removal of the stent and repeat endoscopy for stent replacement. 18 We reviewed our experience with using SEMS to manage GI disorders in the foregut and compared our 702026SRI XX X 10.1177/1553350617702026Surgical InnovationSinger et al research-article 2017 1 University Hospitals Case Medical Center, Cleveland, OH, USA 2 Case Western Reserve University School of Medicine, Cleveland, OH, USA Corresponding Author: Jordan L. Singer, Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA. Email: jls347@case.edu Predictive Factors for the Migration of Endoscopic Self-Expanding Metal Stents Placed in the Foregut Jordan L. Singer, BA 1,2 , Amir H. Aryaie, MD 1 , Mojtaba Fayezizadeh, MD 1 , Jon Lash 1 , and Jeffrey M. Marks, MD 1 Abstract Background. With recent advancements in endoscopy, self-expandable metal stents (SEMS) have been used to treat gastrointestinal leaks, perforations, and strictures. Stent migration frequently complicates management and often requires additional treatments to reach resolution. Our study aimed to determine predictive factors for stent migration. Methods. Consecutive procedures involving SEMS placed with and without fixation after upper gastrointestinal surgery between 2009 and 2014 were retrospectively reviewed. Demographic, surgical history, rate of stent migration, and stent characteristic data were collected. Rates of stent migration were compared. Results. We reviewed 214 consecutive procedures involving stents placed in the foregut. Median duration of stent placement was 4.0 ± 10.3 weeks. Forty-three (20%) stents migrated after placement. Of those, 27 (63%) required stent replacement. Eleven (5%) procedures utilized stent fixation and 203 (95%) did not. Fixation techniques included endoscopic clips (9%), endoscopic sutures (73%), and transnasal sutures (18%). Stent migration rate was not different between those with and those without fixation (P = .2). Rate of migration was significantly higher in procedures involving fully covered stents (P < .001). Migration occurred after esophagectomy and gastric bypass (P < .001 and P < .05, respectively) and in patients with diabetes (P < .01). Conclusions. A challenge with SEMS use is stent migration. Diabetes and using fully covered stents were associated with migration as were SEMS used to treat complications of esophagectomy and gastric bypass. Stent fixation was not associated with the prevention of stent migration. No pattern was found that favors an approach to reduce stent migration. Keywords flexible endoscopy, esophageal surgery, gastric surgery