Removing in situ esophageal stents

Abstract

We read with interest the article “Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases.”1Van Halsema E.E. Wong Kee Song L.M. et al.Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases.Gastrointest Endosc. 2013; 77: 18-28Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar We believe there are some considerations that should be made regarding 2 subsets of patients who should have not been included in this study and that possibly explain the unusually extraordinary results reported by the authors. In the first place, patients needing an inner stent for the “stent in stent” retrieving technique should not have been accounted for, because in this technique the inner stent is not in contact with the esophageal wall. We also noticed that 91 stents had migrated, mostly to the stomach; this represents around 30% of the reported stents. We consider that these patients should have been excluded from the study because they represent a completely different subset of patients; in this group, stents were never fixed to the mucosa, avoiding the principal risk during retrieval, which is pulling the embedded portion of the stent from the mucosa.Finally, we would like to mention that we have found in our unpublished series that other stents with higher radial force, as the Zilver Wilson-Cook partially covered esophageal stents, seem to be harder to remove than Wallflex stents. Maybe in future studies patients should be separated into particular subgroups according to diagnosis, removal technique, the endoscopist's experience, and other variables. We read with interest the article “Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases.”1Van Halsema E.E. Wong Kee Song L.M. et al.Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases.Gastrointest Endosc. 2013; 77: 18-28Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar We believe there are some considerations that should be made regarding 2 subsets of patients who should have not been included in this study and that possibly explain the unusually extraordinary results reported by the authors. In the first place, patients needing an inner stent for the “stent in stent” retrieving technique should not have been accounted for, because in this technique the inner stent is not in contact with the esophageal wall. We also noticed that 91 stents had migrated, mostly to the stomach; this represents around 30% of the reported stents. We consider that these patients should have been excluded from the study because they represent a completely different subset of patients; in this group, stents were never fixed to the mucosa, avoiding the principal risk during retrieval, which is pulling the embedded portion of the stent from the mucosa. Finally, we would like to mention that we have found in our unpublished series that other stents with higher radial force, as the Zilver Wilson-Cook partially covered esophageal stents, seem to be harder to remove than Wallflex stents. Maybe in future studies patients should be separated into particular subgroups according to diagnosis, removal technique, the endoscopist's experience, and other variables. Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseasesGastrointestinal EndoscopyVol. 77Issue 1PreviewTemporary placement of self-expandable stents has been increasingly used for the management of benign esophageal diseases. Full-Text PDF ResponseGastrointestinal EndoscopyVol. 78Issue 1PreviewWe thank Baptista and colleagues for the interest in our article and appreciate the effort to send us a letter with their comments. The issue that was raised about the stent being in contact with the esophageal wall and getting fixed to the mucosa was not a mandatory criterion for inclusion into our study. We focused on the safety of esophageal stent removal in general, and all temporary stents were therefore included for analysis. Full-Text PDF