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

Tomas DaVee, Shayan Irani, Cadman Leggett, Manuel Berzosa Corella, Karina V. Grooteman, Louis Michel Wong Kee Song, Michael B. Wallace, Richard A. Kozarek, Todd H. Baron

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Removal of embedded partially covered self-expanding metal stents (PCSEMS) is associated with an increased risk of adverse events compared with removal of fully covered self-expanding stents (FCSES) due to tissue ingrowth. Successful removal of embedded PCSEMS has been described by the stent-in-stent (SIS) technique.Aims: To report the first US experience from three high-volume quaternary care centers on the safety and efficacy of the SIS technique for removal of embedded PCSEMS.Methods: Retrospective study of outcomes for consecutive patients who underwent the SIS for removal of embedded PCSEMS over a 5-year period. Results: Twenty-seven embedded PCSEMS were successfully removed using the SIS technique (100 %) from 25 patients (11 males), median age 65 (range 37–80). All stents were successfully removed in one endoscopic session (no repeat SIS procedures were required for persistently embedded stents). The embedded PCSEMS had been in situ for a median of 76 days (range 26–501). Median SIS dwell time (FCSES in situ of PCSEMS) was 13 days (interquartile range 8–16 days; range 4–212 days). One adverse event (self-limited bleeding) occurred during a median follow-up period of 3 months (range 1–32). No patients died, required surgery, or had long-term disability due to adverse events attributed to the SIS technique. Twelve patients required additional interventions following SIS procedure for persistence or recurrence of the underlying pathology. Conclusion: When performed by experienced endoscopists, safe and effective removal of embedded PCSEMS can be achieved via the SIS technique.

Original languageEnglish (US)
JournalSurgical Endoscopy and Other Interventional Techniques
DOIs
StateAccepted/In press - Sep 28 2015

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Stents
Metals

Keywords

  • Advanced therapeutic endoscopy
  • Anastomotic perforation or leak
  • Embedded stents
  • Endoscopic stents
  • Esophageal cancer
  • Esophageal strictures

ASJC Scopus subject areas

  • Surgery

Cite this

Stent-in-stent technique for removal of embedded partially covered self-expanding metal stents. / DaVee, Tomas; Irani, Shayan; Leggett, Cadman; Berzosa Corella, Manuel; Grooteman, Karina V.; Wong Kee Song, Louis Michel; Wallace, Michael B.; Kozarek, Richard A.; Baron, Todd H.

In: Surgical Endoscopy and Other Interventional Techniques, 28.09.2015.

Research output: Contribution to journalArticle

DaVee, Tomas ; Irani, Shayan ; Leggett, Cadman ; Berzosa Corella, Manuel ; Grooteman, Karina V. ; Wong Kee Song, Louis Michel ; Wallace, Michael B. ; Kozarek, Richard A. ; Baron, Todd H. / Stent-in-stent technique for removal of embedded partially covered self-expanding metal stents. In: Surgical Endoscopy and Other Interventional Techniques. 2015.
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title = "Stent-in-stent technique for removal of embedded partially covered self-expanding metal stents",
abstract = "Background: Removal of embedded partially covered self-expanding metal stents (PCSEMS) is associated with an increased risk of adverse events compared with removal of fully covered self-expanding stents (FCSES) due to tissue ingrowth. Successful removal of embedded PCSEMS has been described by the stent-in-stent (SIS) technique.Aims: To report the first US experience from three high-volume quaternary care centers on the safety and efficacy of the SIS technique for removal of embedded PCSEMS.Methods: Retrospective study of outcomes for consecutive patients who underwent the SIS for removal of embedded PCSEMS over a 5-year period. Results: Twenty-seven embedded PCSEMS were successfully removed using the SIS technique (100 {\%}) from 25 patients (11 males), median age 65 (range 37–80). All stents were successfully removed in one endoscopic session (no repeat SIS procedures were required for persistently embedded stents). The embedded PCSEMS had been in situ for a median of 76 days (range 26–501). Median SIS dwell time (FCSES in situ of PCSEMS) was 13 days (interquartile range 8–16 days; range 4–212 days). One adverse event (self-limited bleeding) occurred during a median follow-up period of 3 months (range 1–32). No patients died, required surgery, or had long-term disability due to adverse events attributed to the SIS technique. Twelve patients required additional interventions following SIS procedure for persistence or recurrence of the underlying pathology. Conclusion: When performed by experienced endoscopists, safe and effective removal of embedded PCSEMS can be achieved via the SIS technique.",
keywords = "Advanced therapeutic endoscopy, Anastomotic perforation or leak, Embedded stents, Endoscopic stents, Esophageal cancer, Esophageal strictures",
author = "Tomas DaVee and Shayan Irani and Cadman Leggett and {Berzosa Corella}, Manuel and Grooteman, {Karina V.} and {Wong Kee Song}, {Louis Michel} and Wallace, {Michael B.} and Kozarek, {Richard A.} and Baron, {Todd H.}",
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AU - DaVee, Tomas

AU - Irani, Shayan

AU - Leggett, Cadman

AU - Berzosa Corella, Manuel

AU - Grooteman, Karina V.

AU - Wong Kee Song, Louis Michel

AU - Wallace, Michael B.

AU - Kozarek, Richard A.

AU - Baron, Todd H.

PY - 2015/9/28

Y1 - 2015/9/28

N2 - Background: Removal of embedded partially covered self-expanding metal stents (PCSEMS) is associated with an increased risk of adverse events compared with removal of fully covered self-expanding stents (FCSES) due to tissue ingrowth. Successful removal of embedded PCSEMS has been described by the stent-in-stent (SIS) technique.Aims: To report the first US experience from three high-volume quaternary care centers on the safety and efficacy of the SIS technique for removal of embedded PCSEMS.Methods: Retrospective study of outcomes for consecutive patients who underwent the SIS for removal of embedded PCSEMS over a 5-year period. Results: Twenty-seven embedded PCSEMS were successfully removed using the SIS technique (100 %) from 25 patients (11 males), median age 65 (range 37–80). All stents were successfully removed in one endoscopic session (no repeat SIS procedures were required for persistently embedded stents). The embedded PCSEMS had been in situ for a median of 76 days (range 26–501). Median SIS dwell time (FCSES in situ of PCSEMS) was 13 days (interquartile range 8–16 days; range 4–212 days). One adverse event (self-limited bleeding) occurred during a median follow-up period of 3 months (range 1–32). No patients died, required surgery, or had long-term disability due to adverse events attributed to the SIS technique. Twelve patients required additional interventions following SIS procedure for persistence or recurrence of the underlying pathology. Conclusion: When performed by experienced endoscopists, safe and effective removal of embedded PCSEMS can be achieved via the SIS technique.

AB - Background: Removal of embedded partially covered self-expanding metal stents (PCSEMS) is associated with an increased risk of adverse events compared with removal of fully covered self-expanding stents (FCSES) due to tissue ingrowth. Successful removal of embedded PCSEMS has been described by the stent-in-stent (SIS) technique.Aims: To report the first US experience from three high-volume quaternary care centers on the safety and efficacy of the SIS technique for removal of embedded PCSEMS.Methods: Retrospective study of outcomes for consecutive patients who underwent the SIS for removal of embedded PCSEMS over a 5-year period. Results: Twenty-seven embedded PCSEMS were successfully removed using the SIS technique (100 %) from 25 patients (11 males), median age 65 (range 37–80). All stents were successfully removed in one endoscopic session (no repeat SIS procedures were required for persistently embedded stents). The embedded PCSEMS had been in situ for a median of 76 days (range 26–501). Median SIS dwell time (FCSES in situ of PCSEMS) was 13 days (interquartile range 8–16 days; range 4–212 days). One adverse event (self-limited bleeding) occurred during a median follow-up period of 3 months (range 1–32). No patients died, required surgery, or had long-term disability due to adverse events attributed to the SIS technique. Twelve patients required additional interventions following SIS procedure for persistence or recurrence of the underlying pathology. Conclusion: When performed by experienced endoscopists, safe and effective removal of embedded PCSEMS can be achieved via the SIS technique.

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KW - Anastomotic perforation or leak

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KW - Endoscopic stents

KW - Esophageal cancer

KW - Esophageal strictures

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