Published online Feb 16, 2014. doi: 10.4253/wjge.v6.i2.49
Revised: December 10, 2013
Accepted: January 15, 2014
Published online: February 16, 2014
The use of self-expandable metallic stents has increased recently to palliate inoperable esophageal neoplasia and also in the management of benign strictures. Migration is one of the most common complications after stent placement and the endoscopist should be able to recognize and manage this situation. Several techniques for managing migrated stents have been described, as well as new techniques for preventing stent migration. Most stents have a “lasso” at the upper flange which facilitates stent repositioning or removal. An overtube, endoloop and large polypectomy snare may be useful for the retrieval of stents migrated into the stomach. External fixation of the stent with Shim’s technique is efficient in preventing stent migration. Suturing the stent to the esophageal wall, new stent designs with larger flanges and double-layered stents are promising techniques to prevent stent migration but they warrant validation in a larger cohort of patients.
Core tip: Migration of self-expandable esophageal stents occurs in up to 36% of cases. The lasso system available in most stents provides a safe way to remove or reposition the stent while it is still in the esophagus. However, when the stent migrates into the stomach, other techniques are needed to guarantee a safer retrieval. The use of clipping, suturing or external fixation should be considered for stents at high risk for migration.