Background: Endoscopic stenting is a widely used method for managing esophageal anastomotic leaks
and perforations. Self-expanding metal stents (SEMSs) have proved effective in sealing
these defects, with a lower rate of displacement than that of self-expanding plastic
stents (SEPSs) as a result of tissue proliferation and granulation tissue ingrowth
at the uncovered portion of the stent, which anchor the prosthesis to the esophageal
wall. Removal of a fully embedded stent is challenging because of the risk of bleeding
and tears.
Materials and methods: Temporary placement of a new stent within the first stent (stent-in-stent technique)
may facilitate the mobilization and safe removal of both stents by inducing pressure
ischemia of the granulation tissue. We report our own experience with the stent-in-stent
technique in five consecutive patients in whom a partially covered Ultraflex stent
had previously been implanted and compare our results with those in the current literature.
Results: The first SEMSs remained in place for a median of 40 days (range 18 – 68) without
displacement. Placement of the new stent was technically successful in all patients.
All stents were left in place for a median of 9 days. The overall stent-in-stent success
rate was 100 % for the removal of embedded stents. No serious adverse events related
to the procedure occurred.
Conclusion: The procedure was safe, well tolerated, and effective. The use of a partially covered
Ultraflex stent of the same size as the old stent for a limited time (≤ 6 days) was
consistently successful.
