Endoscopic Removal of Embedded Self-Expanding Esophageal Metal Stents

Abstract

Endoscopic Removal of Embedded Self-Expanding Esophageal Metal Stents Wilfried Veltzke-Schlieker, Andreas Adler, Rainer Hintze, Hassan Rebeye, Bertram Wiedenmann, Thomas Rosch Background: Selfexpanding metal stents have become standard treatment for obstructing esophageal cancer as well as for sealing of esophageal and anastomotic fistulas. Removal of those stents appears desirable in some malignant conditions but also for intermittent treatment of benign strictures. We present a standardized approach for endoscopic removal of these stents. Patients and Methods: During a six year period, metal stents were placed in 172 patients, and in 20 cases stents (all Ultraflex covered stents, Boston Scientific) had to be endoscopically removed. Reasons were dysfunction in 12 cases (3 dislocations, 5 intractable pain, 4 misplacements) and in 8 cases stent removal was planned after 8-12 weeks in patients with anastomotic leaks. Two methods were applied: In firmly embedded stents, the metal mesh was longitudinally dissected using a Neodym-Yag laser, followed by extraction of the middle stent body after radial dissection at both noncovered inner ends. The remaining filaments at the proximal and distal end were then partially removed as far as tissue embedding allowed. Method 2 consisted of bougienage dislocation in less firmly fixed stents, whereby the bougie traversed the distal stent ends, thus pushing the stent distally removing it from the underlying tissue, and finally extracting it. Results: In 16 patients method 1 was successfully applied, whereas method 2 led to stent removal in two cases. In the remaining patients both methods were used in combination. In all cases stents could be removed successfully and without significant complications in 1.3 session.Only in one case oesophagus dilatation was nesseary due to stenosis. Conclusions: Endoscopic stent removal is feasible and safe even in stents embedded in the esophageal wall by ingrowth of non-covered ends. This opens further possibilities of applications in benign conditions.