Self-expanding Removable Metal Stents Research Articles

Fluoroscopic removal of self-expandable metallic airway stent in patients with airway stenosis.

To study the safety and efficacy of fluoroscopic removal of self-expandable metallic stent for airway stenosis.We conducted a retrospective analysis of 67 consecutive patients, 39 male and 28 female, who underwent fluoroscopic stent removal from March 2011 to April 2017. The patients ranged in age from 12 to 85 years. Seventy-six airway stents were implanted, 70 covered stents and 6 bare stents, including 9 stents for second stent implantation after removal. All patients underwent chest computed tomography scans with/without bronchoscopy before stent removal. The indication of stent removal and postinterventional complications were analyzed retrospectively.Seventy-four of 76 airway stents were successfully removed, only 2 stent showed retained struts after removal, for a technical success rate of 97.4%. Two patients died of complications (1 hemorrhage and 1 respiratory failure), resulting in a clinical success rate of 94.7%. Five stents showed strut fracture and the remaining 71 stents were removed in 1 piece. Indications for stent removal include planned removal (n = 40), excessive granulation tissue (n = 15), intolerance of stenting (n = 6), inadequate expansion and deformation (n = 5), stent migration (n = 5), replacement of bare stent (n = 4), and strut fracture (n = 1). There were 17 complications of stent removal: death from massive bleeding (n = 1), restenosis requires stenting (n = 9), strut fracture or residue (n = 5), dyspnea requires mechanical ventilation (n = 2). The survival rates were 83.8%, 82.1%, and 82.1% for 0.5, 3, and 6 years.Fluoroscopic removal of airway stent is technically feasible and effective. Stents are recommended for removal within 3 months for treating airway stenosis.

Self-expandable metal stents for the extraction of common bile duct stones in patients receiving dual antiplatelet agents: a pilot study.

Endoscopic sphincterotomy or endoscopic papillary balloon dilatation during endoscopic retrograde cholangiopancreatography (ERCP) are associated with a high risk of bleeding in patients receiving dual antiplatelet agents (APAs). However, the discontinuation of antiplatelet agents increases the risk of thromboembolic events in these patients. To date, the placement of self-expandable metal stents (SEMSs) in patients receiving dual APAs has not been well investigated. The aim of this study was to evaluate the feasibility and safety of SEMS placement for the removal of common bile duct (CBD) stones in patients in whom APAs were not discontinued. Ten consecutive patients who were suspected of having CBD stones and who were receiving dual APAs were prospectively enrolled and underwent temporary SEMS placement, followed by stone extraction and SEMS removal. The patients continued taking dual APAs at the time of undergoing the procedure. SEMS placement was successful in all ten patients. Complete duct clearance with the SEMSs was achieved in a single session in all patients with CBD stones (9/9, 100%). One patient had cholangitis, but ERCP did not reveal biliary stones. There were no cases of bleeding during or after the procedure, even though all patients continued to take dual APAs. There were no new thromboembolic events. SEMSs can be used for the extraction of CBD stones in patients on dual APAs, and does not lead to hemorrhagic or thromboembolic events.

Nursing of endoscopic full-covered self-expanding removable metal stents implantation for bile duct anastomotic strictures after liver transplantation

Objective To investigate the nursing points of endoscopic full-covered self-expanding removable metal stents (FCSERMS) implantation for bile duct anastomotic strictures after liver transplantation. Methods The clinical data of patients who were treated by endoscopic full-covered self-expanding removable metal stents implantation for bile duct anastomotic strictures after liver transplantation from January 2013 to July 2015 were retrospectively analyzed, and the nursing process were summarized. Results The group of 9 patients were successfully placed and removed with FCSERMS. There was no postoperative complication, such as stent migration, acute pancreatitis, biliary bleeding and intestinal leakage. All the bile duct strictures were relieved after FCSERMS removement. Followed up for 10-32 months, there was no symptom and sign of bile duct anastomotic stricture recurrent. Conclusions The key in nursing points of FCSERMS implantation for bile duct anastomotic strictures after liver transplantation are introducing the function of FCSERMS and therapeutic process to improve patient compliance, mastering the endoscopic operations, the placement and removal method of FCSERMS to short operation time, strengthening postoperative nasal bile duct care, paying attention to the observation, detection and treatment of postoperative complications after the metal stent placement and removement, as well as the continuing care during the period between placement and removment of FCSERMS. Key words: Liver transplantation; Nursing care; Bile duct anastomotic stricture; Endoscopic retrograde cholangiopancreatography; Removable metal stent

Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent

AIMTo assess the long-term outcomes of this procedure after removal of self-expandable metal stent (SEMS). The efficacy and safety of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with SEMS were also assessed.METHODSBetween January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUS-GBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. The SEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured.RESULTSThe rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient (8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d (78-1492).CONCLUSIONEUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction.

Removable metal stents in treating perioperative refractory biliary hemorrhage patients with cirrhosis and common bile duct stone

Endoscopic retrograde cholangiopancreatonraphy (ERCP) is the main treatment modality for common bile duct stone. Biliary hemorrhage easily occurred in patients suffe-ring from cirrhosis during and after ERCP. From May 2012 to May 2016, 8 cases diagnosed with cirrhosis and common bile duct stones who developed post-ERCP refractory biliary hemorrhage were treated with full-covered self-expanding removable metal stents (FCSERMS), including 5 cases with perioperative hemorrhage of ERCP and 3 cases with delayed onset of biliary hemorrhage post ERCP. All the patients were successfully implanted with FCSERMS. Seven patients had successful hemostasis, and the other one case with ineffective hemostasis was treated with interventional arterial embolization later. Four stents were removed within 4 weeks and one in 8 months after ERCP. No evidence of biliary hemorrhage, intestinal fistula and other complications was observed during removal procedures. Spontaneous stent dislodgment occurred in one patient in postoperative 4 weeks, one patient died of liver failure in postoperative 6 months and one patient carried FCSERMS for 23 months. Key words: Endoscopic retrograde cholangiopancreatonraphy; Endoscopic sphincterotomy; Common bile duct stones; Biliary hemorrhage; Removable metal stent; Cirrhosis

Choledochoscopic high-frequency needle-knife electrotomy for treatment of anastomotic strictures after Roux-en-Y hepaticojejunostomy

BackgroundAnastomotic stricture is a complex and substantial complication following Roux-en-Y hepaticojejunostomy. Initially, endoscopic and percutaneous approaches are often attempted, but the gold standard remains surgical biliary reconstruction, especially for refractory stricture. However, this solution leaves much room for improvement, due to the challenging nature of the biliary reconstruction procedure, in which anastomotic stricture may still occur.AimsTo investigate the feasibility and effectiveness of choledochoscopic high-frequency needle-knife electrotomy as an intervention in the treatment of anastomotic strictures following Roux-en-Y hepaticojejunostomy.MethodsFrom February 2010 to October 2014, clinical data was collected and retrospectively compared for patients who underwent balloon dilation or/and choledochoscopic high-frequency needle-knife electrotomy for the treatment of anastomotic strictures after Roux-en-Y hepaticojejunostomy.ResultsA total of 38 patients underwent successful choledochoscopic treatment and all the anastomotic strictures were removed successfully, 19 of which were treated with electrotomy, 7 with balloon dilation, and 12 with both electrotomy and balloon dilation. Among these groups,the average operating times were 6.9 ± 2.4 min,10.1 ± 6.8 min, and 20.2 ± 13.5 min, respectively. The average stent supporting times were 6.3 ± 0.7 months, 6.5 ± 0.6 months, and 6.1 ± 0.4 respectively. The mean follow-up after stent removal was 42.1 ± 27.4 months, and in 26.3 % (5/19), 28.5 % (2/7) and 16.7 % (2/12) of cases, recurrent anastomotic stricture occurred. Of these 9 total patients with recurrent anastomotic, two patients were successfully rescued by full-covered self-expanding removable metal stents and 7 patients by electrotomy combined with balloon dilation.ConclusionsCholedochoscopic high-frequency needle-knife electrotomy is both feasible and safe in the treatment of anastomotic stricture after Roux-en-Y hepaticojejunostomy, with a similar long-term outcome to balloon dilation in treating anastomotic stricture after Roux-en-Y hepaticojejunostomy. A combination of choledochoscopic electrotomy concurrent with balloon dilation should be recommended based on the low rate of recurrence.

Removable self-expanding metal stents insertion for the treatment of perforations and postoperative leaks of the esophagus.

Esophageal rupture, spontaneous or iatrogenic, is associated with significant morbidity and mortality. The current study aims at highlighting the various clinical scenarios, where esophageal fully covered self-expanding removable metal stents (FCSEMS) can be used in esophageal rupture. In patients who underwent insertion of FCSEMS between January 2013 and June 2014, all data regarding demographics, indications, insertion, removal, and outcomes were studied retrospectively. Seven patients underwent the placement of esophageal covered SEMS. Two patients had Boerhaave syndrome, two had leak following the repair of aortic aneurysm, one had extensive esophageal injury following transesophageal echocardiography, one had carcinoma esophagus with tracheaesophageal fistula, and one had dehiscence of esophagogastric anastomosis. Stent insertion was successful in all the patients; one had stent migration which was managed endoscopically. Two patients died due to underlying illness; the rest had successful removal of stents after 8-10weeks and good outcomes. Esophageal FCSEMS placement is safe and effective modality in management of patients with esophageal rupture.

Stent-in-Stent Technique for the Treatment of Proximal Bronchial Restenosis after Insertion of Metallic Stents: A Report of Two Cases.

Endoscopic treatment of a bronchial restenosis previously treated by insertion of a partially covered self-expandable metallic stent (SEMS) can be difficult. Classically, after recanalization of the bronchus, the stent is removed and replaced by a more adapted one. We report on two cases of proximal bronchial restenosis treated by insertion of an additional stent inside the lumen of the previously inserted stent using the stent-in-stent (SIS) technique. The indications for the initial stent were malignancy in Patient 1 and posttransplant bronchial stenosis in Patient 2. Restenosis occurred at the proximal end of the stent within months in both cases. Stent removal and insertion of a new stent were considered, but this option was discarded because of an excessive risk of bronchial perforation and preference towards an alternative approach. In both cases, a second customized SEMS was placed using the SIS technique after ablation of the proximal end stenosis of the stent by argon plasma coagulation and/or dilation with a balloon. Recanalization of the bronchus was achieved in both cases without complications. The SIS technique is a valuable alternative to removal of SEMS in case of proximal bronchial restenosis.

Literature Analysis of the Treatment of Benign Esophageal Disease with Stent.

To analyze the efficacy and safety of benign esophageal disease used biodegradable (BD) stent or metal stent. The English literatures of benign esophageal disease that were treated by biodegradable or metal stents implantation were retrieved and summarized. In all 323 benign esophageal disease, the most common etiologies were benign refractory stricture, surgical anastomotic stricture and esophageal fistula/leak/perforation, but the main characteristics between the two groups were not significantly different. One hundred fifty-four cases were completely healed by using BD stents or self-expandable metal stents (SEMS) (47.7%). Clinical success was achieved in 47.7% of all patients and there was no significant difference between BD stents (51%) and SEMS (46.2%) (P = 0.472), while stent migration occurred more frequently with SEMS (33.9%) than with BD stent (19.6%) (P ≤ 0.05), and tissue in- or overgrowth occurred more frequently with SEMS (22.2%) than with BD stents (8.8%) (P ≤ 0.05). Furthermore, the time about degradation of BD stents in esophageal was longer than removal of SEMS from the esophagus (P ≤ 0.05). Placement of BD stents or SEMS provides effective and safe relief for benign esophageal disease. Clinical success and mortality were not significantly different. BD stents offers an advantage of fewer complications. Although stent placement is a viable strategy in patients with benign esophageal disease, the ideal treatment strategy and further randomized trials with large number of patients are needed.

Prevention and treatment of complications for full-covered self-expanding removable metal stents in malignant obstructive jaundice

To explore the prevention and treatment of complications for full-covered self-expanding removable metal stents (FCSERMS) in malignant obstructive jaundice. The clinical data were analyzed retrospectively for 45 cases undergoing endoscopic biliary FCSERMS drainage for malignant obstructive jaundice from May 2012 to March 2014. Among them, 45 cases were successful one time. The parameters of liver function improved significantly with a jaundice efficiency of 91.1%. There were 4 dead cases. Among 19 cases of early complications, hyperamylasemia (n = 8), acute mild pancreatitis (n = 4), acute cholecystitis (n = 2) and hemobilia (n = 1) recovered after conservative treatments. Acute suppurative cholecystitis (n = 2) and acute obstructive suppurative cholangitis (n = 2) were cured by percutaneous transhepatic cholangial drainage (PTCD) and percutaneous transhepatic gallbladder drainage (PTGBD). And late complications of obstructive jaundice (n = 3), acute suppurative cholecystitis (n = 4), acute cholangitis (n = 2), hepatophyma (n = 2) and acute pancreatitis (n = 1) were cured by endoscopic retrograde cholangiopancreatography (ERCP), PTCD and PTGBD. Various complications are associated with FCSERMS in malignant obstructive jaundice.However, positive and effective prevention and proper treatment reduce the incidence of complications.

Esophageal stent fixation with endoscopic suturing device (with video)

Esophageal self-expandable stents were introduced into clinical practice in the early 1990s and are now frequently placed to palliate dysphagia in patients with benign and malignant esophageal obstruction. 1 van Heel N.C. Haringsma J. Winhoven B.P. et al. Endoscopic removal of self-expandable metal stents from the esophagus (with video). Gastrointest Endosc. 2011; 74: 44-50 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 2 Baron T.H. Expandable stents in the treatment of esophageal obstruction UpToDate 2012. http://www.uptodate.com/contents/expandable-stents-in-the-treatment-of-esophageal-obstruction?source=search_result&search=esophageal+stents&selectedTitle=1%7E41 Google Scholar , 3 Schembre D. Advances in esophageal stenting: the evolution of fully covered stents for malignant and benign disease. Adv Ther. 2010; 27: 413-425 Crossref PubMed Scopus (22) Google Scholar In addition, esophageal stents are often are used to facilitate healing of fistulas, perforations, and anastomotic leaks. 4 Swinnen J. Eisendrath P. Rigaux J. et al. Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc. 2011; 73: 890-899 Abstract Full Text Full Text PDF PubMed Scopus (136) Google Scholar , 5 van Boeckel P.G. Sijbring A. Vleggaar F.P. et al. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther. 2011; 33: 1292-1301 Crossref PubMed Scopus (179) Google Scholar Although placement of esophageal stents is technically easy and safe, these stents are quite expensive, and spontaneous stent migration often requires repeat endoscopy for removal of the migrated stent and placement of a new stent. 6 Knyrim K. Wagner H.J. Bethge N. et al. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med. 1993; 329: 1302-1307 Crossref PubMed Scopus (726) Google Scholar , 7 Kozarek R.A. Raltz S. Brugge W.R. et al. Prospective multicenter trial of esophageal Z-stent placement for malignant dysphagia and tracheoesophageal fistula. Gastrointest Endosc. 1996; 44: 562-567 Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar , 8 Martinez J.C. Puc M.M. Quiros R.M. Esophageal stenting in the setting of malignancy. ISRN Gastroenterol. 2011; 2011: 719575 PubMed Google Scholar

Safety and efficacy of self-expanding removable metal esophageal stents during neoadjuvant chemotherapy for resectable esophageal cancer

Patients with esophageal cancer may present with dysphagia and weight loss. Resectable lesions require consideration of neoadjuvant chemotherapy, which improves survival but have side effects, which compound already poor intake. Prevention of malnutrition has historically required interventions such as surgical jejunostomy or percutaneous endoscopic gastrostomy, which carry associated morbidity. With established roles in palliation, self-expanding removable metal stents (SERMS) may provide an alternative intervention in resectable disease. We sought to evaluate outcomes from our unit's introduction of SERMS in dysphagic patients prior to esophagectomy. All dysphagic patients presenting with esophageal cancer and considered for curative surgery between April 2006 and November 2008 were offered preoperative treatment of dysphagia with SERMS during neoadjuvant chemotherapy. Baseline and preoperative outcomes assessed included dysphagia score and nutritional markers. Sixteen patients underwent esophageal stenting during neoadjuvant therapy of whom 7/16 (44%) were female with mean age 63 (53-76). In 12/16 (75%), tumors were located in the lower one third of the esophagus. There was a significant fall in mean dysphagia score from 2.5 (range 1-4) to 1.1 (range 0-3) immediately preoperatively. There was no significant change in serum albumin, weight, or body mass index. Stent-related morbidity occurred in 4/16 (25%) patients and stomach migration occurred in 7/16 (43.8%). All were resolved endoscopically and there was no stent-related mortality. Of 10/16 (62.5%) patients ultimately progressing to esophagectomy, 30-day mortality was 6.3%. Anastomotic leak occurred in one patient (10%) and R1 resection rate was 20%. SERMS are a safe and effective intervention in dysphagic patients undergoing neoadjuvant chemotherapy for esophageal cancer. Complications are minor and readily treatable with endoscopy. Objective parameters suggest nutritional status is maintained and symptoms are improved. SERMS do not appear to compromise resection.

Endoscopic removal of self-expandable metal stents from the esophagus (with video)

Self-expandable metals stents (SEMSs) have increasingly been used as a temporary device to bridge chemoradiotherapy in patients with malignant esophageal disease or in patients with benign esophageal defects or stenosis. To evaluate the outcome of removal of SEMSs in a large cohort of patients with benign and malignant esophageal disease. Observational study with standardized treatment and follow-up. Single university center. Between 2001 and 2010, 95 consecutive patients referred for endoscopic SEMS extraction were included. Endoscopic stent removal. Technical and functional outcome and complications. A total of 124 stent extractions were undertaken in 95 patients; both partially covered (68%) and fully covered (32%) SEMSs were removed. Three patients had 2 overlapping SEMSs in place. Successful primary removal was achieved in 89%; the secondary removal rate was 96%. Uncomplicated primary removal rate was significantly higher for fully covered versus partially covered stents (P = .035) and for single versus overlapping stents (P = .033). Patients with a complicated stent removal had the stent in place significantly longer compared with patients with an uncomplicated primary stent removal (126 days vs 28 days; P = .01). Surgical removal was required in 3 patients (2.4%). Six moderate and severe complications (5%) related to the endoscopic extraction occurred. Retrospective, nonrandomized study design. Primary endoscopic removal of an SEMS is feasible in the majority of patients with benign and malignant esophageal disease. A longer time that a stent is in place and the use of partially covered SEMSs both impede removal. Moreover, overlapping SEMSs should be avoided for temporary use because stent disintegration and subsequent complications may occur.

Removal of Self-Expandable Metallic Stents: Is It Possible?

Self-expandable metallic stents (SEMS) have become an important component of the management of central airway disease. These stents are not, however, without problems and stent-related complications (SRCs) can be more formidable to treat than the original indication for SEMS placement. As use of SEMS has increased, the number of patients returning to hospital for management of SRCs has similarly risen. A small group of these patients will have, as their only therapeutic option, stent removal Thus far limited experience exists with late stent removal. Stent extraction is difficult and requires expertise in a variety of techniques. A multidisciplinary approach to both SEMS placement and extraction is strongly advocated.