Advertisement
Original Investigation|Articles in Press

Effectiveness of the Interventional Technique for the Removal of Self-Expanding Metallic Esophageal Stents Under Fluoroscopy

Published:March 07, 2023DOI:https://doi.org/10.1016/j.acra.2022.11.029

      Rationale and Objectives

      Timely removal of esophageal stents can help avoid or reduce the occurrence of complications. This study was aimed at elucidating the interventional technique for the removal of self-expanding metallic esophageal stents (SEMESs) under fluoroscopy and analyzing its safety and efficacy.

      Materials and Methods

      The medical records of patients who underwent removal of SEMESs by interventional techniques under fluoroscopy were retrospectively analyzed. Furthermore, the success and adverse event rates for different interventional techniques of stent removal were analyzed and compared.

      Results

      Overall, 411 patients were included, and 507 metallic esophageal stents were removed. There were 455 and 52 fully and partially covered SEMESs, respectively. According to the stent indwelling time, benign esophageal diseases were divided into two groups: ≤68 days and >68 days. There was a significant difference in the incidence of complications between the two groups (13.1% and 30.5%, respectively, p < .001). The stents in cases of malignant esophageal lesions were divided into the following two groups: ≤52 days and >52 days. Intergroup differences in complication incidence were not significant (p = .81) Further, there was a significant difference in removal time between the recovery line pull and proximal adduction techniques (4 and 6 minutes, respectively, p < .001). In addition, the recovery line pull technique was associated with a lower rate of complications (9.8% vs 19.1 %, p = .04). There was no statistical difference in the technical success rate and incidence of adverse events between the inversion and stent-in-stent techniques.

      Conclusion

      Interventional technique to remove SEMESs under fluoroscopy is safe, effective, and worthy of clinical application.

      Key Words

      Abbreviations:

      SEMESs (Self-expanding metallic esophageal stents), PCSEMESs (Partially covered self-expanding metallic esophageal stents), FCSEMESs (Fully covered self-expanding metallic esophageal stents), SIS (Stent-in-stent)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Spaander MC
        • Baron TH
        • Siersema PD
        • et al.
        Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.
        Endoscopy. 2016; 48: 939-948https://doi.org/10.1055/s-0042-114210
        • Balazs A
        • Kupcsulik PK
        • Galambos Z.
        Esophagorespiratory fistulas of tumorous origin. Non-operative management of 264 cases in a 20-year period.
        Eur J Cardiothorac Surg. 2008; 34: 1103-1107https://doi.org/10.1016/j.ejcts.2008.06.025
        • Zhao H
        • Zhou Y
        • Feng J
        • et al.
        Literature analysis of the treatment of benign esophageal disease with stent.
        Indian J Surg. 2016; 78: 6-13https://doi.org/10.1007/s12262-015-1294-8
        • Medeiros VS
        • Martins BC
        • Lenz L
        • et al.
        Adverse events of self-expandable esophageal metallic stents in patients with long-term survival from advanced malignant disease.
        Gastrointest Endosc. 2017; 86: 299-306https://doi.org/10.1016/j.gie.2016.12.017
        • van Heel NC
        • Haringsma J
        • Wijnhoven BP
        • et al.
        Endoscopic removal of self-expandable metal stents from the esophagus (with video).
        Gastrointest Endosc. 2011; 74: 44-50https://doi.org/10.1016/j.gie.2011.02.020
        • Yan SL
        • Chen CH
        • Yeh YH
        • et al.
        Endoscopic removal of an embedded partially covered esophageal self-expandable metallic stent by overtube technique.
        Endoscopy. 2011; 43: E400-E401https://doi.org/10.1055/s-0030-1256945
        • Hill C
        • Khalil BK
        • Barola S
        • et al.
        Inversion technique for the removal of partially covered self-expandable metallic stents.
        Obes Surg. 2018; 28: 161-168https://doi.org/10.1007/s11695-017-2811-6
        • Hirdes MM
        • Siersema PD
        • Houben MH
        • et al.
        Stent-in-stent technique for removal of embedded esophageal self-expanding metal stents.
        Am J Gastroenterol. 2011; 106: 286-293https://doi.org/10.1038/ajg.2010.394
        • Yin M
        • Wang S
        • Wang M
        • et al.
        Inversion technique under fluoroscopy for removal of self-expanding nitinol esophageal stent after long-term placement: review of 107 consecutive cases.
        Surg Endosc. 2022; 36: 5692-5697https://doi.org/10.1007/s00464-022-09238-2
        • Yang G
        • Wang S
        • Yin M
        Stent-in-stent technique under fluoroscopy for removal of embedded esophageal stent: a retrospective case series.
        Quant Imaging Med Surg. 2022; 12: 3813-3820https://doi.org/10.21037/qims-21-1039
        • Cotton PB
        • Eisen GM
        • Aabakken L
        • et al.
        A lexicon for endoscopic adverse events: report of an ASGE workshop.
        Gastrointest Endosc. 2010; 71: 446-454https://doi.org/10.1016/j.gie.2009.10.027
        • van Halsema EE
        • van Hooft JE.
        Clinical outcomes of self-expandable stent placement for benign esophageal diseases: a pooled analysis of the literature.
        World J Gastrointest Endosc. 2015; 7: 135-153https://doi.org/10.4253/wjge.v7.i2.135
        • Schweigert M
        • Dubecz A
        • Stadlhuber RJ
        • et al.
        Treatment of intrathoracic esophageal anastomotic leaks by means of endoscopic stent implantation.
        Interact Cardiovasc Thorac Surg. 2011; 12: 147-151https://doi.org/10.1510/icvts.2010.247866
        • Elkhouly MA
        • Attar BM
        • Elkafrawy AA
        • et al.
        Acquired broncho-esophageal fistula after 10 years of esophageal stent placement.
        Am J Gastroenterol. 2019; 114: S965-S966https://doi.org/10.14309/01.ajg.0000596428.94302.99
        • Vasilikostas G
        • Sanmugalingam N
        • Khan O
        • et al.
        'Stent in a stent'–an alternative technique for removing partially covered stents following sleeve gastrectomy complications.
        Obes Surg. 2014; 24: 430-432https://doi.org/10.1007/s11695-013-1163-0
        • DaVee T
        • Irani S
        • Leggett CL
        • et al.
        Stent-in-stent technique for removal of embedded partially covered self-expanding metal stents.
        Surg Endosc. 2016; 30: 2332-2341https://doi.org/10.1007/s00464-015-4475-4
        • Coomber RS
        • Patel PH
        • Dhir A
        • et al.
        Endoscopic laser fragmentation and removal of a nonremovable metal esophageal stent for persistent dysphagia: a technical note.
        Surg Endosc. 2012; 26: 1791-1793https://doi.org/10.1007/s00464-011-2111-5
        • Eloubeidi MA
        • Lopes TL.
        Novel removable internally fully covered self-expanding metal esophageal stent: feasibility, technique of removal, and tissue response in humans.
        Am J Gastroenterol. 2009; 104: 1374-1381https://doi.org/10.1038/ajg.2009.133
        • Leers JM
        • Vivaldi C
        • Schäfer H
        • et al.
        Endoscopic therapy for esophageal perforation or anastomotic leak with a self-expandable metallic stent.
        Surg Endosc. 2009; 23: 2258-2262https://doi.org/10.1007/s00464-008-0302-5