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DOI: 10.1055/s-2006-944969
Endoscopic removal of biliary self-expandable metallic stents: a prospective study
Publication History
Submitted 2 February 2006
Accepted after revision 4 August 2006
Publication Date:
11 December 2006 (online)
![](https://www.thieme-connect.de/media/endoscopy/200612/lookinside/thumbnails/10.1055-s-2006-944969-1.jpg)
Background and study aims: The transpapillary endoscopic insertion of self-expandable metallic stents (SEMSs) has been widely used for the palliation of unresectable malignant biliary obstruction. We attempted the endoscopic removal of malfunctioning SEMSs. The aim of this study was to assess the feasibility and safety of the endoscopic removal of SEMSs by comparing the results between removal of covered and uncovered SEMSs.
Patients and methods: 30 patients with a malfunctioning biliary SEMS prospectively underwent an attempt at endoscopic removal of the biliary SEMS over a 2-year period. Removal of the malfunctioning SEMS was done with a therapeutic duodenoscope (ED-450XT5 or TJF-240), using a rat-tooth forceps. Of the 30 SEMS used, 22 were silicone-covered Wallstents, while eight were uncovered SEMSs including five uncovered Wallstents and three Zilver stents. The time for an attempt at each endoscopic removal was limited to 15 minutes in a single endoscopic procedure session.
Results: The covered SEMSs were easily removed in 19 out of 22 patients (86.4 %), whereas none of the eight uncovered SEMSs (0 %) could be removed. The only factor predicting successful stent removal was the presence of a stent covering (P = 0.000). There was no morbidity or mortality related to endoscopic removal of malfunctioning stents.
Conclusions: In contrast to uncovered biliary SEMSs, in most cases malfunctioning covered biliary SEMSs can be easily and safely removed endoscopically using a rat-tooth forceps.
References
- 1 Smith A C, Dowsett J F, Russell R C. et al . Randomised trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction. Lancet. 1994; 344 1655-1660
- 2 Andersen J R, Sorensen S M, Kruse A. et al . Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut. 1989; 30 1132-1135
- 3 Davids P H, Groen A K, Rauws E A. et al . Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992; 340 1488-1492
- 4 Irving J D, Adam A, Dick R. et al . Gianturco expandable metallic biliary stents: results of a European clinical trial. Radiology. 1989; 172 321-326
- 5 Huibregtse K, Cheng J, Coene P P. et al . Endoscopic placement of expandable metal stents for biliary strictures - a preliminary report on experience with 33 patients. Endoscopy. 1989; 21 280-282
- 6 Lammer J. Biliary endoprostheses. Plastic versus metal stents. Radiol Clin N Am. 1990; 28 1211-1222
- 7 Lee M J, Mueller P R, Saini S. et al . Occlusion of biliary endoprostheses: presentation and management. Radiology. 1990; 176 531-534
- 8 Born P, Neuhaus H, Rosch T. et al . Initial experience with a new, partially covered Wallstent for malignant biliary obstruction. Endoscopy. 1996; 28 699-702
- 9 Shim C S, Lee Y H, Cho Y D. et al . Preliminary results of a new covered biliary metal stent for malignant biliary obstruction. Endoscopy. 1998; 30 345-350
- 10 Isayama H, Komatsu Y, Tsujino T. et al . Polyurethane-covered metal stent for management of distal malignant biliary obstruction. Gastrointest Endosc. 2002; 55 366-370
- 11 Kahaleh M, Tokar J, Le T. et al . Removal of self-expandable metallic Wallstents. Gastrointest Endosc. 2004; 60 640-644
- 12 Familiari P, Bulajic M, Mutignani M. et al . Endoscopic removal of malfunctioning biliary self-expandable metallic stents. Gastrointest Endosc. 2005; 62 903-910
- 13 Levy M J, Wiersema M J. Endoscopic removal of a biliary Wallstent with a suture-cutting device in a patient with primary pancreatic lymphoma. Endoscopy. 2002; 34 835-837
- 14 Egan L J, Baron T H. Endoscopic removal of an embedded biliary Wallstent by piecemeal extraction. Endoscopy. 2000; 32 492-494
- 15 Ahmed A, Keeffe E B, Imperial J C. A novel technique for endoscopic removal of expandable biliary Wallstent. Gastrointest Endosc. 1999; 50 279-281
- 16 Tham T C, Carr-Locke D L, Vandervoort J. et al . Management of occluded biliary Wallstents. Gut. 1998; 42 703-707
- 17 Bueno J T, Gerdes H, Kurtz R C. Endoscopic management of occluded biliary Wallstents: a cancer center experience. Gastrointest Endosc. 2003; 58 879-884
- 18 Petersen B T. SEMS removal: salvage technique or new paradigms. Gastrointest Endosc. 2005; 62 911-913
- 19 Uchida N, Tsutsui K, Ezaki T. et al . Estimation of the stent placement above the intact sphincter of Oddi against malignant bile duct obstruction. J Gastroenterol. 2005; 40 291-296
- 20 Baron T H, Poterucha J J. Insertion and removal of covered expandable metal stents for closure of complex biliary leaks. Clin Gastroenterol Hepatol. 2006; 4 381-386
- 21 Lopez Jr R R , Cosenza C A, Lois J. et al . Long-term results of metallic stents for benign biliary strictures. Arch Surg. 2001; 136 664-669
M.-H. Kim, M. D.
Department of Internal Medicine · Asan Medical Center
388-1 Pungnap-dong, Songpa-gu · Seoul 138-736 · Korea
Fax: +822-476-0824
Email: mhkim@amc.seoul.kr