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Stent-in-stent, a safe and effective technique to remove fully embedded esophageal metal stents: case series and literature review.

Aiolfi A, Bona D, Ceriani C, Porro M, Bonavina L - Endosc Int Open (2015)

Bottom Line: Placement of the new stent was technically successful in all patients.The procedure was safe, well tolerated, and effective.The use of a partially covered Ultraflex stent of the same size as the old stent for a limited time (≤ 6 days) was consistently successful.

View Article: PubMed Central - PubMed

Affiliation: University of Milan, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, Milan, Italy.

ABSTRACT

Background: Endoscopic stenting is a widely used method for managing esophageal anastomotic leaks and perforations. Self-expanding metal stents (SEMSs) have proved effective in sealing these defects, with a lower rate of displacement than that of self-expanding plastic stents (SEPSs) as a result of tissue proliferation and granulation tissue ingrowth at the uncovered portion of the stent, which anchor the prosthesis to the esophageal wall. Removal of a fully embedded stent is challenging because of the risk of bleeding and tears.

Materials and methods: Temporary placement of a new stent within the first stent (stent-in-stent technique) may facilitate the mobilization and safe removal of both stents by inducing pressure ischemia of the granulation tissue. We report our own experience with the stent-in-stent technique in five consecutive patients in whom a partially covered Ultraflex stent had previously been implanted and compare our results with those in the current literature.

Results: The first SEMSs remained in place for a median of 40 days (range 18 - 68) without displacement. Placement of the new stent was technically successful in all patients. All stents were left in place for a median of 9 days. The overall stent-in-stent success rate was 100 % for the removal of embedded stents. No serious adverse events related to the procedure occurred.

Conclusion: The procedure was safe, well tolerated, and effective. The use of a partially covered Ultraflex stent of the same size as the old stent for a limited time (≤ 6 days) was consistently successful.

No MeSH data available.


Related in: MedlinePlus

 The proximal (a) and distal (b) cups of the old Ultraflex stent after the stent-in-stent procedure. There is no evidence of residual granulation tissue. The rat-toothed forceps are useful to grasp the proximal retrieval string for removal (c).
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FI161-3:  The proximal (a) and distal (b) cups of the old Ultraflex stent after the stent-in-stent procedure. There is no evidence of residual granulation tissue. The rat-toothed forceps are useful to grasp the proximal retrieval string for removal (c).

Mentions: Placement of the new stent was technically successful in all patients (Table 2). A partially covered stent (Ultraflex) was inserted in four procedures, and a fully covered nitinol stent (Wallflex) in two. All stents were left in place for a median of 9 days (range 6 – 17). In four patients, the stents were successfully removed at the planned date (Fig. 3). In the patient with esophageal tumor, it was decided to remove the stent because of the onset of dyspnea related to extrinsic compression of the trachea and left main bronchus. In one patient, complete embedding of the proximal end of the first stent was seen after removal of the second fully covered stent at 17 days after implant. Another partially covered nitinol stent was then placed, and both stents were easily removed after 6 days. The procedural time for removal varied between 20 and 30 minutes.


Stent-in-stent, a safe and effective technique to remove fully embedded esophageal metal stents: case series and literature review.

Aiolfi A, Bona D, Ceriani C, Porro M, Bonavina L - Endosc Int Open (2015)

 The proximal (a) and distal (b) cups of the old Ultraflex stent after the stent-in-stent procedure. There is no evidence of residual granulation tissue. The rat-toothed forceps are useful to grasp the proximal retrieval string for removal (c).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554508&req=5

FI161-3:  The proximal (a) and distal (b) cups of the old Ultraflex stent after the stent-in-stent procedure. There is no evidence of residual granulation tissue. The rat-toothed forceps are useful to grasp the proximal retrieval string for removal (c).
Mentions: Placement of the new stent was technically successful in all patients (Table 2). A partially covered stent (Ultraflex) was inserted in four procedures, and a fully covered nitinol stent (Wallflex) in two. All stents were left in place for a median of 9 days (range 6 – 17). In four patients, the stents were successfully removed at the planned date (Fig. 3). In the patient with esophageal tumor, it was decided to remove the stent because of the onset of dyspnea related to extrinsic compression of the trachea and left main bronchus. In one patient, complete embedding of the proximal end of the first stent was seen after removal of the second fully covered stent at 17 days after implant. Another partially covered nitinol stent was then placed, and both stents were easily removed after 6 days. The procedural time for removal varied between 20 and 30 minutes.

Bottom Line: Placement of the new stent was technically successful in all patients.The procedure was safe, well tolerated, and effective.The use of a partially covered Ultraflex stent of the same size as the old stent for a limited time (≤ 6 days) was consistently successful.

View Article: PubMed Central - PubMed

Affiliation: University of Milan, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, Milan, Italy.

ABSTRACT

Background: Endoscopic stenting is a widely used method for managing esophageal anastomotic leaks and perforations. Self-expanding metal stents (SEMSs) have proved effective in sealing these defects, with a lower rate of displacement than that of self-expanding plastic stents (SEPSs) as a result of tissue proliferation and granulation tissue ingrowth at the uncovered portion of the stent, which anchor the prosthesis to the esophageal wall. Removal of a fully embedded stent is challenging because of the risk of bleeding and tears.

Materials and methods: Temporary placement of a new stent within the first stent (stent-in-stent technique) may facilitate the mobilization and safe removal of both stents by inducing pressure ischemia of the granulation tissue. We report our own experience with the stent-in-stent technique in five consecutive patients in whom a partially covered Ultraflex stent had previously been implanted and compare our results with those in the current literature.

Results: The first SEMSs remained in place for a median of 40 days (range 18 - 68) without displacement. Placement of the new stent was technically successful in all patients. All stents were left in place for a median of 9 days. The overall stent-in-stent success rate was 100 % for the removal of embedded stents. No serious adverse events related to the procedure occurred.

Conclusion: The procedure was safe, well tolerated, and effective. The use of a partially covered Ultraflex stent of the same size as the old stent for a limited time (≤ 6 days) was consistently successful.

No MeSH data available.


Related in: MedlinePlus