Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases

Abstract

Background: Temporary placement of self-expandable stents has been increasingly used for the management of benign esophageal diseases.

Objective: To evaluate the safety of endoscopic removal of esophageal self-expandable stents placed for the treatment of benign esophageal diseases.

Design: Multicenter retrospective study.

Setting: Six tertiary care centers in the United States and Europe.

Patients: A total of 214 patients with benign esophageal diseases undergoing endoscopic stent removal.

Intervention: Endoscopic stent removal.

Main outcome measurements: Endoscopic techniques for stent removal, time to stent removal, and adverse events related to stent removal.

Results: A total of 214 patients underwent a total of 329 stent extractions. Stents were mainly placed for refractory strictures (49.2%) and fistulae (49.8%). Of the removed stents, 52% were fully covered self-expandable metal stents (FCSEMSs), 28.6% were partially covered self-expandable metal stents (PCSEMSs), and 19.5% were self-expandable plastic stents. A total of 35 (10.6%) procedure-related adverse events were reported, including 7 (2.1%) major adverse events. Multivariate analysis revealed that use of PCSEMSs (P < .001) was a risk factor for adverse events during stent removal. Favorable factors for successful stent removal were FCSEMSs (P ≤ .012) and stent migration (P = .010). No significant associations were found for stent indwelling time (P = .145) and stent embedding (P = .194).

Limitations: Retrospective analysis, only tertiary care centers.

Conclusions: With an acceptable major adverse event rate of 2.1%, esophageal stent removal in the setting of benign disease was found to be a safe and feasible procedure. FCSEMSs were more successfully removed than self-expandable plastic stents and PCSEMSs. Adverse events caused by stent removal were not time dependent.