Plastic tube-assisted gastroscopic removal of embedded esophageal metal stents: A case report

Abstract

A patient with stent embedding after placement of an esophageal stent for an esophagobronchial fistula was treated with an ST-E plastic tube inserted into the esophagus to the upper end of the stent using gastroscopy. The gastroscope was guided into the esophagus through the ST-E tube, and an alligator forceps was inserted into the esophagus through the ST-E tube alongside the gastroscope. Under gastroscopy, the stent wire was grasped with the forceps and pulled into the ST-E tube. When resistance was met during withdrawal, the gastroscope was guided further to the esophageal section where the stent was embedded. Biopsy forceps were guided through a biopsy hole in the gastroscope to the embedded stent to remove silicone membranes and connection threads linking the Z-shaped wire mesh. While the lower section of the Z-shaped stent was fixed by the biopsy forceps, the alligator forceps were used to pull the upper section of the metal wire until the Z-shaped metal loops elongated. The wire mesh of the stent was then removed in stages through the ST-E tube. Care was taken to avoid bleeding and perforation. Under the assistance of an ST-E plastic tube, an embedded esophageal metal stent was successfully removed with no bleeding or perforation. The patient experienced an uneventful recovery after surgery. Plastic tube-assisted gastroscopic removal of embedded metal stents can be minimally invasive, safe, and effective.

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

“…Use of PCSEMS in the treatment of benign diseases is controversial due to the adverse events described during their removal [3,9,17,21,[26][27][28][29][30]. These adverse events may include: hemorrhage, granulation or hyperplasic tissue ingrowth, obstruction, stent fracture, penetration, perforation, avulsion, fistula formation (i.e., tracheoesophageal, esophagoaortic, pericardioesophageal), and epidural abscess formation [1,3,11,17,19,28,[31][32][33][34][35][36][37].…”

“…[18][19][20][21][22][23][24] Short-and long-term data regarding techniques for removal of embedded stents are extremely limited. The OT procedure effectively dislodges the stent in a single procedure, although it potentially increases the risk of bleeding, perforation, and esophageal avulsion.…”

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

“…Different methods for endoscopic removal of an embedded PCSEMS have been described [100][101][102][103][104][105][106]. Most studies have reported on the use of the stent-in-stent technique, which relies on the placement of an additional FCSEMS fully overlapping the location of the embedded PCSEMS.…”