Loss of fractured part of a proximally migrated esophageal stent through vomiting

Abstract

Gomes RM et al. Vomiting of fractured part of a migrated proximal esophageal stent … Endoscopy 2012; 44: E234-E235 UCTN-Unusual cases and technical notes E235

Esophageal Self-Expandable Metal Stents Can Fracture in the Distal Third When Used for Post-Bariatric Surgery Complications: A Single Center Experience and Review of the Literature with Video

“…In addition to the cases presented, there have been 23 previously reported cases of complete fractures [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ] and 37 of partial fractures [ 9 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. A summary of patient demographics and stent characteristics is shown in Table 1 .…”

“…The exact cause of this fracture remains unknown. Several potential reasons have been cited, including stent-related causes such as spontaneous fracture [ 9 , 10 , 11 , 24 , 28 , 31 ], defective material or design [ 10 , 11 , 18 , 27 , 30 ], corrosion effect [ 12 , 19 , 23 , 25 ], and the embedment of the uncovered part of a partially covered stent [ 21 ], and iatrogenic-related causes such as tumor ablation through a metal stent using Nd: YAG laser application, which can cause thermal overstraining [ 28 ], stent removal attempts [ 22 ], and post-deployment balloon dilatation [ 27 ]. We propose additional plausible etiologies that can be categorized into anatomical, physiological, mechanical, and chemical etiologies.…”

“…We report an endoscopic approach to retrieving an impaled stent using a gastric overtube (Supplementary Video S1). Dysphagia [7,[10][11][12]18,20] Coffee ground emesis [10] Regurgation [11] Emesis of fractured Stent particles [21] Abdominal pain [24] Asymptomatic [8,19] First case was asymptomatic while the fifth patient presented with nausea, vomiting and abdominal discomfort.…”

“…Our Cases Some cases were diagnosed by imaging [8,9,[11][12][13]16,20,24,32] Most were diagnosed during or after endoscopic removal All the SEMS fractured in vivo and were noted during or after endoscopic removal. Management Complete SEMS fracture Partial SEMS Fracture Prior Literature 3 patients reported in the literature developed small intestinal obstruction from migration of a fractured part of the stent and required surgical management [12,13,16] 1 developed a gastrocolic fistula also due to the migrated fractured part requiring surgical management [14] 2 passed the stent rectally [8,15] 10 stents were removed endoscopically [7][8][9][10][17][18][19][20][21][22] 2 were left in place [11,12] 2 were asymptomatic and were removed endoscopically after migration of the stents [30] 1 was also asymptomatic and was removed endoscopically after being diagnosed using a contrast enhanced CT scan [9] 2 in which dysphagia occurred were removed endoscopically [31,32] The remaining 23 partially fractured SEMS was not reported, and they were likely left in place given the majority were asymptomatic and working as intended [25-29] Our Cases All our cases underwent endoscopic removal. Our third and sixth cases were managed using a gastric overtube to ensure mucosal protection and prevent fluid leaks.…”