Balloon Dilation-assisted Extraction of Embedded Self-Expandable Metal Stents

Background and study aims: Embedded transpapillary self-expandable metal stents (SEMS) may require extraction over time and standard approaches often fail. In the current study we describe a newly developed approach to refractory embedded SEMS, using balloon dilation-assisted extraction. Our aim was to evaluate the feasibility and outcomes of this novel technique.

Patients and methods: This is an exploratory single-center retrospective analysis of all consecutive patients undergoing endoscopic balloon-assisted stent extraction. Baseline, procedural and follow-up data were collected and analyzed.

Results: Twelve patients with embedded transpapillary SEMS were identified (60.0% female, mean age 70.1 [SD±18.1] years, uncovered SEMS 33.3%) with median dwell time of 457.5 (IQR 175.8-1042) days. Previous extraction attempts were undertaken in the majority of cases (83.3%), including SEMS-in-SEMS placement (41.7%). Using the balloon-assisted stent extraction technique, successful SEMS extraction was achieved in 10 out of 12 cases (83.3%). Adverse events occurred in 3 patients (Grade II [n=2, 16.7%] - Grade III [n=1, 8.3%]). After a median follow-up time of 171 (58-260) days, 1 biliary recurrence occurred for which endoscopic re-evaluation was performed.

Conclusions: Our data suggest that endoscopic balloonassisted stent extraction should be considered for extraction of embedded self-expandable metal stents, as it showed high efficacy without any major procedure-related adverse events, using readily available endoscopic tools.

Keywords: SEMS, uncovered self-expandable metal stents, fc-SEMS, ingrowth, impacted stents.