Endoscopic management and prevention of migrated esophageal stents

Abstract

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.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Endoscopy; Stents; Esophageal cancer; Benign strictures; Complications 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.Martins BC, Retes FA, Medrado BF, Lima MS, Pennacchi CMPS, Kawaguti FS, Safatle-Ribeiro AV, Uemura RS, MalufFilho F. Endoscopic management and prevention of migrated esophageal stents. World J Gastrointest Endosc 2014; 6(2): 49-54 Available from:

Stent-in-stent technique for removal of embedded partially covered self-expanding metal stents

“…These adverse events may include: hemorrhage, granulation or hyperplasic tissue ingrowth, obstruction, stent fracture, penetration, perforation, avulsion, fistula formation (i.e., tracheoesophageal, esophagoaortic, pericardioesophageal), and epidural abscess formation [1,3,11,17,19,28,[31][32][33][34][35][36][37]. Despite these risks, PCSEMS have been used to treat benign esophageal diseases such as caustic strictures, leaks, fistulas and perforations, especially in patients with a prior history of stent migration [28,[38][39][40].…”

Esophageal stents: Beyond the simple stricture

“…Stent migration rates in the mid-esophagus are in the region of 5%, while migration rates of stents placed with the lower end at the stomach average 15% to 20% 1 with some designs performing markedly worse than others. [19][20][21] The risk of migration is increased with subsequent chemo-or radiotherapy.…”

Migration of endoluminal gastroesophageal stents: A case series

“…Migration of endoluminal stents has been a reported and vexing complication occurring in a significant number of cases [2,5,6]. Reports that emphasize use of clips, tandem stenting, or other fixation techniques have suggested that the techniques may provide greater security, although that has not been well demonstrated.…”

“…Stent migration is a common occurrence, reportedly occurring in 30-50% of stent placements following sleeve gastrectomy micro leaks [2,5,6]. In most cases, antegrade stent migration is treated with repeat endoscopy and repositioning of the stent [5].…”