Abs_NVGE10_stent-extraction

							ENDOSCOPIC EXTRACTION OF SELF-EXPANDABLE METAL STENTS FROM THE
ESOPHAGUS: OUTCOME AND COMPLICATIONS IN 107 PROCEDURES

N.C.M. van Heel, J. Haringsma, E.J. Kuipers

Department of Gastroenterology and Hepatology, Erasmus MC University
Medical Center, Rotterdam, the Netherlands

Self-expandable metal stents (SEMS) are increasingly used as a temporary treatment
for patients with benign esophageal lesions, and also to bridge therapy for malignant
disease. Although some of these stents are labeled removable, removal was long
thought to be difficult and complications during stent extraction may occur. The
feasibility of endoscopic stent extraction has largely been underreported. The aim of
the present study was to evaluate the outcome of SEMS extraction in a large cohort of
patients after temporary stent insertion.
This prospective observational cohort study was conducted in a single tertiary referral
center. Between 2001 and 2009, all consecutive patients referred for endoscopic
SEMS extraction were included. Patients with migrated stents were excluded.
Endoscopic stent removal technique depended on stent design.
A total of 107 stent extractions were undertaken in 90 patients (58% male; median age
61 years (range: 14-90 years)) with benign (n=58; 64%) and malignant (n=32; 36%)
esophageal disease. Seventeen patients needed re-stenting with subsequent extraction.
In total, 30 SEMS (28%) were fully covered, and 77 SEMS (72%) were partially
covered. Endoscopic stent extraction was immediately successful (primary removal
rate) in 91% (97/107), extractions were performed in multiple endoscopic sessions
(range 2-7) in 4.7% (5/107), and SEMS were surgically removed in 3.7% (4/107).
One (0.9%) SEMS failed to be removed because of severe tumour tissue ingrowth.
Major complications occurred during or after 7 stent removals (6.5%): 5 stent
fractures, 1 esophageal sleeve mucosectomy with subsequent stenosis after healing, 1
thoracic empyema, 1 osteodiscitis, and 2 self-limiting bleedings.
No significant differences in primary removal rate and complication rate were found
between fully covered vs partially covered stents (97% vs 88%, p=0.28 and 0% vs
9%, p=0.19) and between benign vs malignant disease (90% vs 91%, p=1.00 and 8%
vs 3%, p=0.42). Patients with a complicated stent extraction had had the stent
significantly longer in place as compared to patients with an uncomplicated stent
extraction; 126 days (range: 14-587) vs 28 days (range: 1-393) (p=0.01).
In conclusion, primary endoscopic removal of a self-expandable stent is feasible in
the majority of patients with benign and malignant esophageal disease. However
severe complications during stent extraction do occur, irrespective of the type of stent
or indication. A prolonged stenting period is associated with an increased
complication rate.