A novel technique for endoscopic removal of a migrated colonic stent

Abstract

Endoscopic placement of a self-expandable metal stent is being increasingly recognized as an acceptable treatment for obstructing neoplasms of the colon. Favorable outcomes have been achieved both for palliation in patients with unresectable tumors and as a bridge to surgical resection. 1 De Gregorio MA Mainar A Tejero E Tobio R Alfonso E Pinto I et al. Acute colorectal obstruction: stent placement for palliative treatment—results of a multicenter study. Radiology. 1998; 209: 117-120 PubMed Google Scholar , 2 Maynar A Ferral Wholey M Castaneda-Zuniga W. Treatment of malignant colonic obstruction with metallic stents: the Tejero-Mainan procedure. J Vasc Intervent Radiol. 1997; 8: 39-41 PubMed Google Scholar , 3 Canon CL Baron TH Morgan DE Dean PA Koehler RE. Treatment of colonic obstruction with an expandable metal stent: radiologic features. AJR Am J Roentgenol. 1997; 168: 199-205 Crossref PubMed Scopus (106) Google Scholar , 4 Baron TH Dean PA Yates MR Canon C Koehler RE. Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc. 1998; 47: 277-286 Abstract Full Text Full Text PDF PubMed Scopus (262) Google Scholar , 5 Tejero E Mainar A Fernandez L Tobio R De Gregorio M. New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum. 1994; 37: 1158-1159 Crossref PubMed Scopus (225) Google Scholar , 6 Mainar A De Gregorio MA Tejero E Tobio R Alfonso E Pinto I et al. Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery—results of a multicenter study. Radiology. 1999; 210: 65-69 Crossref PubMed Scopus (190) Google Scholar In most series, initial stent deployment is successful in more than 90% of patients. 4 Baron TH Dean PA Yates MR Canon C Koehler RE. Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc. 1998; 47: 277-286 Abstract Full Text Full Text PDF PubMed Scopus (262) Google Scholar However, stent migration has occurred in 20% to 40% of cases in larger series. 4 Baron TH Dean PA Yates MR Canon C Koehler RE. Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc. 1998; 47: 277-286 Abstract Full Text Full Text PDF PubMed Scopus (262) Google Scholar , 7 Mauro MA Koehler RE Baron TH. Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents. Radiology. 2000; 215: 659-669 Crossref PubMed Scopus (203) Google Scholar In many instances, a migrated stent will pass transanally without incident. 3 Canon CL Baron TH Morgan DE Dean PA Koehler RE. Treatment of colonic obstruction with an expandable metal stent: radiologic features. AJR Am J Roentgenol. 1997; 168: 199-205 Crossref PubMed Scopus (106) Google Scholar , 8 Tack J Gevers AM Rutgeerts P. Self-expandable metal stents in the palliation of rectosigmoidal carcinoma: a follow-up study. Gastrointest Endosc. 1998; 48: 267-271 Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar Other times it may become lodged in the distal colon or rectum, and endoscopic removal can be difficult or impossible, in which case surgical removal is necessary. There are few descriptions of techniques for removal of migrated stents that become lodged in the lower GI tract. Previously described methods include grasping the stent with a biopsy forceps, 4 Baron TH Dean PA Yates MR Canon C Koehler RE. Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc. 1998; 47: 277-286 Abstract Full Text Full Text PDF PubMed Scopus (262) Google Scholar polypectomy snare, or Kelly clamps, and passage of an angiographic catheter and wire through the lumen of the stent followed by extraction with a speculum. 9 Wholey MH Ferral H Reyes R Lopera J Castaneda-Zuniga W Maynar M. Retrieval of migrated colonic stents from the rectum. Cardiovasc Intervent Radiol. 1997; 20: 477-480 Crossref PubMed Scopus (15) Google Scholar This is a report of a novel technique for endoscopic removal of a migrated colonic stent.