Project description: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.
Project description:Endoscopic biliary decompression via stent placement is an important approach for the palliative management of distal malignant biliary obstruction. However, migration of the inserted stent can occur, either distally or proximally; proximal migration is less common, but it also presents a greater challenge for endoscopic resolution. We present a case of a 67-year-old woman who had locally advanced pancreatic cancer and developed a common bile duct obstruction. Upon clinical presentation of chronic, painless, progressive jaundice, the obstruction was managed by placing of a 10?mm?×?60?mm covered self-expandable metal stent (CSEMS), which successfully facilitated palliative biliary drainage. Six months later, however, the patient developed recurrent jaundice, which was determined to be due to proximal migration of the CSEMS. Repeat endoscopic retrograde cholangiography was performed, and initial attempts to retrieve the migrated stent failed. Finally, another 10?mm?×?60?mm CSEMS was placed across the stricture site, inside the previous stent, which remained in place. The treatment resolved the obstruction and jaundice, and the patient experienced no adverse events.