Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases

Background: Temporary placement of self-expandable stents has been increasingly used for the management of benign esophageal diseases. Objective: To evaluate the safety of endoscopic removal of esophageal self-expandable stents placed for the treatment of benign esophageal diseases. Design: Multicenter retrospective study. Setting: Six tertiary care centers in the United States and Europe. Patients: A total of 214 patients with benign esophageal diseases undergoing endoscopic stent removal. Intervention: Endoscopic stent removal. Main Outcome Measurements: Endoscopic techniques for stent removal, time to stent removal, and adverse events related to stent removal. Results: A total of 214 patients underwent a total of 329 stent extractions. Stents were mainly placed for refractory strictures (49.2%) and fistulae (49.8%). Of the removed stents, 52% were fully covered self-expandable metal stents (FCSEMSs), 28.6% were partially covered self-expandable metal stents (PCSEMSs), and 19.5% were self-expandable plastic stents. A total of 35 (10.6%) procedure-related adverse events were reported, including 7 (2.1%) major adverse events. Multivariate analysis revealed that use of PCSEMSs (P <.001) was a risk factor for adverse events during stent removal. Favorable factors for successful stent removal were FCSEMSs (P ≤.012) and stent migration (P =.010). No significant associations were found for stent indwelling time (P =.145) and stent embedding (P =.194). Limitations: Retrospective analysis, only tertiary care centers. Conclusions: With an acceptable major adverse event rate of 2.1%, esophageal stent removal in the setting of benign disease was found to be a safe and feasible procedure. FCSEMSs were more successfully removed than self-expandable plastic stents and PCSEMSs. Adverse events caused by stent removal were not time dependent.