Brief Article
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World J Gastroenterol. Jun 7, 2011; 17(21): 2652-2657
Published online Jun 7, 2011. doi: 10.3748/wjg.v17.i21.2652
Endoscopic removal and trimming of distal self-expandable metallic biliary stents
Kentaro Ishii, Takao Itoi, Atsushi Sofuni, Fumihide Itokawa, Takayoshi Tsuchiya, Toshio Kurihara, Shujiro Tsuji, Nobuhito Ikeuchi, Junko Umeda, Fuminori Moriyasu, Akihiko Tsuchida
Kentaro Ishii, Takao Itoi, Atsushi Sofuni, Fumihide Itokawa, Takayoshi Tsuchiya, Toshio Kurihara, Shujiro Tsuji, Nobuhito Ikeuchi, Junko Umeda, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, 160-0023, Japan
Akihiko Tsuchida, Third Department of Surgery, Tokyo Medical University, Tokyo, 160-0023, Japan
Author contributions: Ishii K and Itoi T contributed equally to this work; Ishii K, Itoi T, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T, Tsuji S, Ikeuchi N and Umeda J performed the research and collected the data; Ishii K, Itoi T, Moriyasu F and Tsuchida A reviewed the data analysis.
Correspondence to: Kentaro Ishii, MD, Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. ishiken@tokyo-med.ac.jp
Telephone: +81-3-33426111 Fax: +81-3-53816654
Received: May 11, 2010
Revised: June 4, 2010
Accepted: June 11, 2010
Published online: June 7, 2011
Abstract

AIM: To evaluate the efficacy and safety of endoscopic removal and trimming of self-expandable metallic stents (SEMS).

METHODS: All SEMS had been placed for distal biliary strictures. Twenty-seven endoscopic procedures were performed in 19 patients in whom SEMS (one uncovered and 18 covered) removal had been attempted, and 8 patients in whom stent trimming using argon plasma coagulation (APC) had been attempted at Tokyo Medical University Hospital. The APC settings were: voltage 60-80 W and gas flow at 1.5 L/min.

RESULTS: The mean stent indwelling period for all patients in whom stent removal had been attempted was 113.7 ± 77.6 d (range, 8-280 d). Of the 19 patients in whom removal of the SEMS had been attempted, the procedure was successful in 14 (73.7%) without procedure-related adverse events. The indwelling period in the stent removable group was shorter than that in the unremovable group (94.9 ± 71.5 d vs 166.2 ± 76.2 d, P = 0.08). Stent trimming was successful for all patients with one minor adverse event consisting of self-limited hemorrhage. Trimming time ranged from 11 to 16 min.

CONCLUSION: Although further investigations on larger numbers of cases are necessary to accumulate evidence, the present data suggested that stent removal and stent trimming is feasible and effective for stent-related complications.

Keywords: Self-expandable metallic stent, Endoscopic biliary stenting, Endoscopic stent removal, Endoscopic stent trimming