Spontaneous Passage of a Dislocated Esophageal Metal Stent: Report of Two Cases

Delayed transpyloric impaction is a very rare complication of esophageal metallic stent placement. Authors report different endoscopic removal techniques, but none of these has been validated yet because of their variable success, time-consuming nature, and risk of perforation and hemorrhage. We report that a ”wait-and-see“ approach is a safe and effective policy in patients with permeable transpyloric impacted esophageal stents.

• 1 Domschke W, Forester E C, Matek W, Rodl W. Self-expanding mesh stent for esophageal cancer stenosis.  Endoscopy. 1990;  22 134-136
• 2 Ramirez F C, Dennert B, Zierer S T, Sanowski R A. Esophageal self-expandable metallic stents - indications, practice, techniques, and complications: results of a national survey.  Gastrointest Endosc. 1997;  45 360-364
• 3 Bartelsman J FW, Bruno M J, Jensema A J. et al . Palliation of patient with oesophagogastric neoplasm by insertion of a covered expandable modified Gianturco-Z endoprosthesis: experience in 153 patients.  Gastrointest Endosc. 2000;  51 134-138
• 4 Wu W C, Katon R M, Saxon R R. et al . Silicone-covered self-expanding metallic stents for the palliation of malignant esophageal and esophagorespiratory fistulas: experience in 32 patients and a review of the literature.  Gastrointest Endosc. 1994;  40 22-23
• 5 Giovanni D, de Palma G, Iovino P, Catanzano C. Distally migrated selfexpanding metal stents: wait-and-see or remove?.  Gastrointest Endosc. 2001;  53 96-98
• 6 Rollhauser C, Fleischer D E. Late migration of a self-expandable metal stent and successful endoscopic management.  Gastrointest Endosc. 1999;  49 541-544
• 7 Begbie S, Briggs G, Levi J. A late complication of palliative stenting of malignant esophageal obstruction.  Aust N Z J Med. 1996;  26 115
• 8 Raijman I, Marcon N R, Kandel G. et al . Repositioning of an esophageal stent after migration using a snare [letter].  Gastrointest Endosc. 1993;  40 652
• 9 Noyer C M, Forohar F. A simple technique to remove migrated esophageal stents.  Am J Gastroenterol. 1998;  93 1595
• 10 Farkas P S, Farkas J D, Koenings K P. An easier method to remove migrated esophageal Z-stents.  Gastrointest Endosc. 1999;  50 277-279
• 11 Mallery S, Freeman M L. Removal of an expanded Ultraflex esophageal stent.  Gastrointest Endosc. 1996;  43 163-165
• 12 Avanish M, Aggarwal M B, Robert B, Camaron M D. Removal of an impacted esophageal endoprosthesis using a through-the-scope balloon.  Gastrointest Endosc. 1993;  39 107-108
• 13 Seiz U, Thonke F, Bohnacker S. et al . Endoscopic extraction of a covered esophageal Z-stent with aid of Endoloops.  Endoscopy. 1998;  30 S91-92
• 14 De Ronde T, Martinet J P, Melange M. Easy removal of migrated self-expanding esophageal metal stent using an Endoloop endoscopic device.  Gastrointest Endosc. 2000;  52 125-127
• 15 Bethge N, Sommer A, Gross U. et al . Human tissue responses to metal stents implanted in vivo for the palliation of malignant stenoses.  Gastrointest Endosc. 1996;  43 596-602