Self-expanding metal stent (SEMS) migration is the most common complication of oesophageal stent placement. A recent systematic review reported an overall migration rate of 17.2%, with rates varying by indication.¹⁻³ To mitigate risk, fixation techniques have been deployed such as over the scope clips (OTSC), endoscopic suturing, and through the scope (TTS) clips. A recent meta analysis demonstrated that fixation significantly reduces migration compared to non-fixation, with all fixation techniques superior to non-fixation.⁴ However, real world efficacy remains uncertain due to a lack of guidance in indication for stent fixation. This audit aimed to identify clinical and anatomical predictors of migration in routine clinical practice. 

Consecutive patients who underwent oesophageal SEMS placement under direct radiological screening between January 2022 and October 2025 were reteroscpectively analysed. The primary outcome was stent migration by 45 days in patients with and without fixation. Secondary outcomes included time-to-migration, migration rates by indication, age, lesion distance, lesion length, and crossing of the gastro-oesophageal junction (GOJ). Statistical analysis was performed using Fisher's exact test, Chi-Square test and Mann-Whitney U test. Multivariable logistic regression was used to assess independent associations with migration. 

Sixty-six (66) patients were identified aged 33-88. Indications included post operative leaks/ perforations, benign strictures and malignant strictures. Overall migration rate was 9% (n=6). Stent fixation was not significantly associated with a change in migration rate: 15.4% with fixation (2/13) compared with 7.5% without fixation (4/53), OR=2.23, p=0.337. Migration rates varied by fixation method: OTSC 10.0% (1/10), Suture 33.3% (1/3), clip 0% (0/1), and no fixation 7.7% (4/52). Patient numbers were not large enough to elucidate statistical significance. Six migration events occurred in stents crossing the GOJ 15.0% (6/40) compared with zero migration events in stents not crossing the GOJ 0% (0/26), p=0.074. Indication influenced migration risk: benign stricture 23.1% (3/13), malignant stricture 5.0% (2/40), OR=5.70, p=0.088; post-operative leaks/perforation 8.3% (1/12). Mean age was similar in migrated (69.8 years) and non-migrated (66.6 years) groups (p=0.55).  Mean time to migration was longer with fixation (mean 39 days) than without (mean 15 days), with patient numbers too low to draw statistical significance. Fixation was selectively used in higher risk indications: malignant 2.5% (1/40), benign 23.1% (3/13), post-operative leaks/perforation 75.0% (3/12). Multivariable regression showed fixation was not independently associated with migration (OR=2.18, p=0.523) after adjusting for indication.  

This audit demonstrates that SEMS GOJ crossing is the strongest anatomical predictor of stent migration, with all migration events occurring in this context. Benign indication carries significantly higher migration risk than malignant disease, consistent with literature implicating the role of tumour anchoring.¹⁻³ In this cohort, stent fixation was preferentially used in inherently higher risk cases and we do not show that stent fixation was associated with reduced migration. We postulate that crude rates in fixation may reflect selection bias; fixation seems preferentially performed in inherently higher risk cases, benign and post-operative leaks/perforation. Limitations included the lack of uniformity in endoscopy report documentation and the subjective interpretation of SEMS positioning using radiology. These findings show varying real world practice. Further prospective research and larger sample sizes are required to interrogate the benefit of various stent fixation modalities, across all indications.