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Stent-in-stent technique for removal of embedded partially covered self-expanding metal stents

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Abstract

Background

Removal of embedded partially covered self-expanding metal stents (PCSEMS) is associated with an increased risk of adverse events compared with removal of fully covered self-expanding stents (FCSES) due to tissue ingrowth. Successful removal of embedded PCSEMS has been described by the stent-in-stent (SIS) technique.

Aims

To report the first US experience from three high-volume quaternary care centers on the safety and efficacy of the SIS technique for removal of embedded PCSEMS.

Methods

Retrospective study of outcomes for consecutive patients who underwent the SIS for removal of embedded PCSEMS over a 5-year period.

Results

Twenty-seven embedded PCSEMS were successfully removed using the SIS technique (100 %) from 25 patients (11 males), median age 65 (range 37–80). All stents were successfully removed in one endoscopic session (no repeat SIS procedures were required for persistently embedded stents). The embedded PCSEMS had been in situ for a median of 76 days (range 26–501). Median SIS dwell time (FCSES in situ of PCSEMS) was 13 days (interquartile range 8–16 days; range 4–212 days). One adverse event (self-limited bleeding) occurred during a median follow-up period of 3 months (range 1–32). No patients died, required surgery, or had long-term disability due to adverse events attributed to the SIS technique. Twelve patients required additional interventions following SIS procedure for persistence or recurrence of the underlying pathology.

Conclusion

When performed by experienced endoscopists, safe and effective removal of embedded PCSEMS can be achieved via the SIS technique.

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Acknowledgments

Core Services performed through Vanderbilt University Medical Center’s Digestive Disease Research Center supported by NIH Grant P30DK058404.

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Authors and Affiliations

  1. Gastroenterology, Vanderbilt University, Nashville, TN, USA

    Tomas DaVee

  2. Gastroenterology, Virginia Mason Medical Center, Seattle, WA, USA

    Shayan Irani & Richard A. Kozarek

  3. Gastroenterology, Mayo Clinic, Rochester, MN, USA

    Cadman L. Leggett, Karina V. Grooteman & Louis-Michel Wong Kee Song

  4. Gastroenterology, Mayo Clinic, Jacksonville, FL, USA

    Manuel Berzosa Corella & Michael B. Wallace

  5. Gastroenterology, University of North Carolina, Chapel Hill, NC, USA

    Todd H. Baron

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  1. Tomas DaVee
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  9. Todd H. Baron
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Correspondence to Todd H. Baron.

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Disclosures

Dr. Irani reports receiving honoraria from Cook Medical, Boston Scientific and W. L. Gore; all benefiting Virginia Mason Medical Center. Dr. Wallace reports consulting relationships with Olympus America and iLumen; and research funding from Boston Scientific and Nine Point. Dr. Kozarek reports receiving research support from the National Institutes of Health and Boston Scientific; publishing royalties from Elsevier, Blackwell and Springer; and honoraria from Cook Endoscopy benefiting Virginia Mason Medical Center. Dr. Baron reports receiving consulting fees from Boston Scientific, Cook Endoscopy, Olympus America, W. L. Gore, and ConMed; travel support from Xlumena, and grant support from Cook Endoscopy. Drs. DaVee, Leggett, Berzosa Corella, Grooteman, and Wong Kee Song have no conflicts of interest or financial ties to disclose.

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DaVee, T., Irani, S., Leggett, C.L. et al. Stent-in-stent technique for removal of embedded partially covered self-expanding metal stents. Surg Endosc 30, 2332–2341 (2016). https://doi.org/10.1007/s00464-015-4475-4

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  • DOI: https://doi.org/10.1007/s00464-015-4475-4

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