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Endoscopic removal of malfunctioning biliary self-expandable metallic stents.

Authors :
Familiari P
Bulajic M
Mutignani M
Lee LS
Spera G
Spada C
Tringali A
Costamagna G
Source :
Gastrointestinal endoscopy [Gastrointest Endosc] 2005 Dec; Vol. 62 (6), pp. 903-10.
Publication Year :
2005

Abstract

Background: Endoscopic removal of malfunctioning self-expandable metallic biliary stents (SEMS) is difficult and not well described. The aim of this study is to review the indications, the techniques, and the results of SEMS removal in a cohort of patients with malfunctioning stents.<br />Methods: All patients who underwent an attempt at endoscopic removal of biliary SEMS over a 5-year period were retrospectively identified. The main indications for SEMS removal were the following: distal migration of the stent or impaction to the duodenum, impaction into the bile-duct wall, tissue ingrowth, and inappropriate length of the stent causing occlusion of intrahepatic ducts. SEMS were removed by using foreign-body forceps or polypectomy snares.<br />Results: Endoscopic removal of 39 SEMS (13 uncovered and 26 covered) was attempted in 29 patients (17 men; mean age, 66 years). SEMS extraction was attempted after a mean of 7.5 months (8.75 months standard deviation) post-SEMS insertion. Removal was successful in 20 patients (68.9%) and in 29 SEMS (74.3%). Covered SEMS were effectively removed more frequently than uncovered ones: 24 of 26 (92.3%) and 5 of 13 (38.4%), respectively (p < 0.05). No major complications were recorded. Multivariate analysis showed that the time interval between insertion and removal, SEMS length, stent-mesh design (zigzag vs. interlaced), and indication for removal were not predictive of success at stent removal.<br />Conclusions: Endoscopic removal of biliary SEMS is feasible and safe in more than 70% of cases. Because only 38% of uncovered SEMS were removable, the presence of a stent covering is the only factor predictive of successful stent extraction. The presence of diffuse and severe ingrowth was the main feature limiting SEMS removal.

Details

Language :
English
ISSN :
0016-5107
Volume :
62
Issue :
6
Database :
MEDLINE
Journal :
Gastrointestinal endoscopy
Publication Type :
Academic Journal
Accession number :
16301035
Full Text :
https://doi.org/10.1016/j.gie.2005.08.051