Endoscopic removal of self-expandable metal stents from the esophagus (with video)
Background: 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. Objective: To evaluate the outcome of removal of SEMSs in a large cohort of patients with benign and malignant esophageal disease. Design: Observational study with standardized treatment and follow-up. Setting: Single university center. Patients: Between 2001 and 2010, 95 consecutive patients referred for endoscopic SEMS extraction were included. Interventions: Endoscopic stent removal. Main Outcome Measurements: Technical and functional outcome and complications. Results: 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. Limitations: Retrospective, nonrandomized study design. Conclusions: 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.