Endoscopic removal of a migrated esophageal covered self-expandable metal stent: the nylon loop pusher-assisted method

Covered self-expandable metal stents (SEMSs) can migrate, with an incidence of more than 30 % [1]. Various techniques for removal of migrated SEMSs have been reported [2] [3] [4]. However, the nylon loop pusher-assisted approach for removal of a distally migrated SEMS has not been reported previously.

A 78-year-old man presented with dysphagia and was eventually diagnosed with a refractory esophageal stricture after endoscopic submucosal resection for an early esophageal cancer. We inserted a fully covered SEMS (20 × 80 mm; Nanjing Minimally Invasive Medical Technology Co., Ltd., Nanjing, China) across the stricture to relieve symptoms. The patient was readmitted after 6 months because of recurrent dysphagia. Gastroscopy using a GIF‐H290 endoscope (Olympus, Tokyo, Japan) showed that the stent had migrated distally, with there being a stenosis above the proximal end of the SEMS ([Fig. 1]). Repeated conventional attempts at removal using a biopsy clamp failed both to grasp the body of the stent and to tighten the upper edge of the stent with a recyclable line.

Fig. 1 Gastroscopic images showing that the self-expandable metal stent (SEMS) had distally migrated with a stenosis above the proximal end of the SEMS as a result of epithelial hyperplasia and partial mucosal ulceration.

We therefore moved to the nylon loop pusher-assisted approach. Slight resistance was encountered when passing the gastroscope (9.8 mm) through the stenosis. The lower edge of the stent was grasped with the metal hook of a nylon loop pusher (Leo Med, Changzhou, China) ([Fig. 2]) and pushed towards the distal esophagus, resulting in the upper edge of the stent becoming separated from the narrow tissue, as expected. After this, we were able to easily grasp the upper edge of the stent again with the metal hook of the nylon loop pusher, and compress the stent ([Fig. 3]). Finally, the stent was gently removed through the esophageal stricture. Post‐procedural gastroscopy revealed mild bleeding from the surface of the stricture and partial mucosal ulceration, but no evidence of lesions elsewhere ([Fig. 4]; [Video 1]).

Fig. 2 Photographs of the nylon loop pusher.

Fig. 3 Endoscopic image showing the upper edge of the stent being grasped with the metal hook of the nylon loop pusher, which allowed the stent to be compressed.

Fig. 4 Post‐procedural gastroscopic image showing mild bleeding from the surface of the stricture and partial mucosal ulceration.

Video 1 A new safe and effective method using the metal hook of a nylon loop pusher is demonstrated for removal of the migrated esophageal covered self-expandable metal stent.

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Fully covered SEMSs are being increasingly used for the benign esophageal diseases, and stent migration is a common complication. Here we provide a new safe and effective method using the metal hook of a nylon loop pusher for when removal of a migrated stent is difficult.

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• References

• 1 Vanbiervliet G, Filippi j, Karimdjee B. et al. The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study. Surg Endosc 2012; 26: 53-59
• 2 Toya Y, Yamada S, Yanai S. et al. Gastrointestinal: Endoscopic removal of a migrating esophageal metallic stent. J Gastroenterol Hepatol 2021; 36: 1151
• 3 Martins B, Sorbello MP, Retes F. et al. Endoscopic removal of migrated esophageal stent--the “grasper and pusher” method. Endoscopy 2012; 44: E10
• 4 Xubiao N, Chaoqiang F, Shiming Y. et al. Endoscopic removal of migrated esophageal stent: the “cap-assisted” method. Endoscopy 2021; 53: 267-268