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Stent Removal (Plastic and Metal)

  • Feng Li
  • Prabhleen Chahal
  • Manuel Perez-Miranda
Chapter
  • 147 Downloads

Abstract

Pancreatic and biliary stents are widely used for a variety of benign and malignant conditions causing obstruction of the bile duct or pancreatic duct. In this chapter, we discuss removal of biliary and pancreatic stents, including indications for removal, techniques of removal, and complications. Difficult stent removal is sometimes challenging; so, knowing the techniques to overcome the difficulties is fundamental to resolve the most difficult cases. These techniques should be known by any biliopancreatic endoscopist together with indications and timing to remove the stents correctly.

Keywords

Biliary stent Plastic stent Stent removal ERCP Difficult stent removal 

References

  1. 1.
    Costamagna G, Mutignani M, Rotondano G, Cipolletta L, Ghezzo L, Foco A, et al. Hydrophilic hydromer-coated polyurethane stents versus uncoated stents in malignant biliary obstruction: a randomized trial. Gastrointest Endosc. 2000;51(1):8–11.CrossRefGoogle Scholar
  2. 2.
    England RE, Martin DF, Morris J, Sheridan MB, Frost R, Freeman A, et al. A prospective randomised multicentre trial comparing 10 Fr Teflon Tannenbaum stents with 10 Fr polyethylene Cotton-Leung stents in patients with malignant common duct strictures. Gut. 2000;46(3):395–400.CrossRefGoogle Scholar
  3. 3.
    Sawas T, Al Halabi S, Parsi MA, Vargo JJ. Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis. Gastrointest Endosc. 2015;82(2):256–67.e7.CrossRefGoogle Scholar
  4. 4.
    van Boeckel PG, Vleggaar FP, Siersema PD. Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review. BMC Gastroenterol. 2009;9:96.CrossRefGoogle Scholar
  5. 5.
    Ishii K, Itoi T, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T, et al. Endoscopic removal and trimming of distal self-expandable metallic biliary stents. World J Gastroenterol. 2011;17(21):2652–7.CrossRefGoogle Scholar
  6. 6.
    Katsinelos P, Kountouras J, Paroutoglou G, Chatzimavroudis G, Paikos D, Zavos C, et al. Migration of plastic biliary stents and endoscopic retrieval: an experience of three referral centers. Surg Laparosc Endosc Percutan Tech. 2009;19(3):217–21.CrossRefGoogle Scholar
  7. 7.
    Diller R, Senninger N, Kautz G, Tubergen D. Stent migration necessitating surgical intervention. Surg Endosc. 2003;17(11):1803–7.CrossRefGoogle Scholar
  8. 8.
    Sherman S, Hawes RH, Uzer MF, Smith MT, Lehman GA. Endoscopic stent exchange using a guide wire and mini-snare. Gastrointest Endosc. 1993;39(6):794–9.CrossRefGoogle Scholar
  9. 9.
    Vila JJ, Marcos K, Manuel PM. Retrieval of proximally migrated pancreatic stents. Video J Encycl GI Endosc. 2013;1(2):584–7.CrossRefGoogle Scholar
  10. 10.
    Soehendra N, Maydeo A, Eckmann B, Brückner M, Ch Nam V, Grimm H. A new technique for replacing an obstructed biliary endoprosthesis. Endoscopy. 1990;22(06):271–2.CrossRefGoogle Scholar
  11. 11.
    Soehendra Stent Retriever Cook Medical; 2019. https://www.cookmedical.com/products/esc_ssr_webds/.
  12. 12.
    Martin DF. Wire guided balloon assisted endoscopic biliary stent exchange. Gut. 1991;32(12):1562.CrossRefGoogle Scholar
  13. 13.
    Hirdes MMC, Siersema PD, Houben MHMG, Weusten BLAM, Vleggaar FP. Stent-in-stent technique for removal of embedded esophageal self-expanding metal stents. Am J Gastroenterol. 2010;106:286.CrossRefGoogle Scholar
  14. 14.
    Arias Dachary FJ, Chioccioli C, Deprez PH. Application of the “covered-stent-in-uncovered-stent” technique for easy and safe removal of embedded biliary uncovered SEMS with tissue ingrowth. Endoscopy. 2010;42(S 02):E304–E5.CrossRefGoogle Scholar
  15. 15.
    Tan DM, Lillemoe KD, Fogel EL. A new technique for endoscopic removal of uncovered biliary self-expandable metal stents: stent-in-stent technique with a fully covered biliary stent. Gastrointest Endosc. 2012;75(4):923–5.CrossRefGoogle Scholar
  16. 16.
    Kahaleh M, Tokar J, Le T, Yeaton P. Removal of self-expandable metallic wall stents. Gastrointest Endosc. 2004;60(4):640–4.CrossRefGoogle Scholar
  17. 17.
    Levy MJ, Wiersema MJ. Endoscopic removal of a biliary wallstent with a suture-cutting device in a patient with primary pancreatic lymphoma. Endoscopy. 2002;34(10):835–7.CrossRefGoogle Scholar
  18. 18.
    Sakai Y, Tsuyuguchi T, Ishihara T, Sugiyama H, Eto R, Fujimoto T, et al. Cholangiopancreatography troubleshooting: the usefulness of endoscopic retrieval of migrated biliary and pancreatic stents. Hepatobiliary Pancreat Dis Int. 2009;8(6):632–7.PubMedGoogle Scholar
  19. 19.
    Mahajan A, Ho H, Sauer B, Phillips MS, Shami VM, Ellen K, et al. Temporary placement of fully covered self-expandable metal stents in benign biliary strictures: midterm evaluation (with video). Gastrointest Endosc. 2009;70(2):303–9.CrossRefGoogle Scholar
  20. 20.
    Buscaglia JM, DiMaio CJ, Pollack MJ, Shin EJ, Harris MD, Richards R, et al. Are large side holes associated with reduced rates of pancreatic stent occlusion? Results of a prospective study. JOP. 2009;10:496–500.PubMedGoogle Scholar
  21. 21.
    Lawrence C, Cotton PB, Romagnuolo J, Payne KM, Rawls E, Hawes RH. Small prophylactic pancreatic duct stents: an assessment of spontaneous passage and stent-induced ductal abnormalities. Endoscopy. 2007;39(12):1082–5.CrossRefGoogle Scholar
  22. 22.
    Moon S-H, Kim M-H, Park DH, Song TJ, Eum J, Lee SS, et al. Modified fully covered self-expandable metal stents with antimigration features for benign pancreatic-duct strictures in advanced chronic pancreatitis, with a focus on the safety profile and reducing migration. Gastrointest Endosc. 2010;72(1):86–91.CrossRefGoogle Scholar
  23. 23.
    Price LH, Brandabur JJ, Kozarek RA, Gluck M, Traverso WL, Irani S. Good stents gone bad: endoscopic treatment of proximally migrated pancreatic duct stents. Gastrointest Endosc. 2009;70(1):174–9.CrossRefGoogle Scholar
  24. 24.
    Rahimi A, Ejtehadi F. SpyGlass pancreatoscopy and successful retrieval of a proximally migrated pancreatic stent; unusual case and technical tips. Middle East J Dig Dis. 2016;8(3):232–4.CrossRefGoogle Scholar
  25. 25.
    Maydeo A, Bhandari S, Bapat M, Mathew P, Kwek A. Sp848 Spyglass pancreatoscopy-guided cannulation and retrieval of a deeply migrated pancreatic duct stent. Gastrointest Endosc. 2011;73(4):AB107.CrossRefGoogle Scholar
  26. 26.
    Moffatt DC, Cote GA, Fogel EL, Watkins JL, McHenry L, Lehman GA, et al. Acute pancreatitis after removal of retained prophylactic pancreatic stents. Gastrointest Endosc. 2011;73(5):980–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Feng Li
    • 1
  • Prabhleen Chahal
    • 1
  • Manuel Perez-Miranda
    • 2
  1. 1.Cleveland Clinic, Ohio State UniversityColumbusUSA
  2. 2.Hospital Universitario Rio HortegaValladolidSpain

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