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

Emo E. Van Halsema, Louis M. Wong Kee Song, Todd H. Baron, Peter D. Siersema, Frank P. Vleggaar, Gregory G. Ginsberg, Pari M. Shah, David E. Fleischer, Shiva K. Ratuapli, Paul Fockens, Marcel G W Dijkgraaf, Giacomo Rando, Alessandro Repici, Jeanin E. Van Hooft

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)18-28
Number of pages11
JournalGastrointestinal Endoscopy
Volume77
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

Esophageal Diseases
Stents
Safety
Therapeutics
Tertiary Care Centers
Plastics

Keywords

  • CI
  • confidence interval
  • FCSEMS
  • fully covered self-expandable metal stent
  • interquartile range
  • IQR
  • odds ratio
  • OR
  • partially covered self-expandable metal stent
  • PCSEMS
  • self-expandable metal stent
  • self-expandable plastic stent
  • SEMS
  • SEPS

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Van Halsema, E. E., Wong Kee Song, L. M., Baron, T. H., Siersema, P. D., Vleggaar, F. P., Ginsberg, G. G., ... Van Hooft, J. E. (2013). Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases. Gastrointestinal Endoscopy, 77(1), 18-28. https://doi.org/10.1016/j.gie.2012.09.001

Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases. / Van Halsema, Emo E.; Wong Kee Song, Louis M.; Baron, Todd H.; Siersema, Peter D.; Vleggaar, Frank P.; Ginsberg, Gregory G.; Shah, Pari M.; Fleischer, David E.; Ratuapli, Shiva K.; Fockens, Paul; Dijkgraaf, Marcel G W; Rando, Giacomo; Repici, Alessandro; Van Hooft, Jeanin E.

In: Gastrointestinal Endoscopy, Vol. 77, No. 1, 01.2013, p. 18-28.

Research output: Contribution to journalArticle

Van Halsema, EE, Wong Kee Song, LM, Baron, TH, Siersema, PD, Vleggaar, FP, Ginsberg, GG, Shah, PM, Fleischer, DE, Ratuapli, SK, Fockens, P, Dijkgraaf, MGW, Rando, G, Repici, A & Van Hooft, JE 2013, 'Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases', Gastrointestinal Endoscopy, vol. 77, no. 1, pp. 18-28. https://doi.org/10.1016/j.gie.2012.09.001
Van Halsema EE, Wong Kee Song LM, Baron TH, Siersema PD, Vleggaar FP, Ginsberg GG et al. Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases. Gastrointestinal Endoscopy. 2013 Jan;77(1):18-28. https://doi.org/10.1016/j.gie.2012.09.001
Van Halsema, Emo E. ; Wong Kee Song, Louis M. ; Baron, Todd H. ; Siersema, Peter D. ; Vleggaar, Frank P. ; Ginsberg, Gregory G. ; Shah, Pari M. ; Fleischer, David E. ; Ratuapli, Shiva K. ; Fockens, Paul ; Dijkgraaf, Marcel G W ; Rando, Giacomo ; Repici, Alessandro ; Van Hooft, Jeanin E. / Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases. In: Gastrointestinal Endoscopy. 2013 ; Vol. 77, No. 1. pp. 18-28.
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AU - Van Halsema, Emo E.

AU - Wong Kee Song, Louis M.

AU - Baron, Todd H.

AU - Siersema, Peter D.

AU - Vleggaar, Frank P.

AU - Ginsberg, Gregory G.

AU - Shah, Pari M.

AU - Fleischer, David E.

AU - Ratuapli, Shiva K.

AU - Fockens, Paul

AU - Dijkgraaf, Marcel G W

AU - Rando, Giacomo

AU - Repici, Alessandro

AU - Van Hooft, Jeanin E.

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N2 - 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.

AB - 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.

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KW - self-expandable plastic stent

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