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

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• 作者：Emo E. van Halsema ; MBBS¹ ; Louis M. Wong Kee Song ; MD² ; Todd H. Baron ; MD ; FASGE² ; Peter D. Siersema ; MD ; PhD³ ; Frank P. Vleggaar ; MD ; PhD³ ; Gregory G. Ginsberg ; MD⁴ ; Pari M. Shah ; MD ; MSCE⁴ ; David E. Fleischer ; MD⁵ ; Shiva K. Ratuapli ; MBBS⁵ ; Paul Fockens ; MD ; PhD ; FASGE¹ ; Marcel G.W. Dijkgraaf ; PhD⁶ ; Giacomo Rando ; MD⁷ ; Alessandro Repici ; MD⁷ ; Jeanin E. van Hooft ; MD ; PhD¹ ;
• 关键词：CI ; confidence interval ; FCSEMS ; fully covered self-expandable metal stent ; IQR ; interquartile range ; OR ; odds ratio ; PCSEMS ; partially covered self-expandable metal stent ; SEMS ; self-expandable metal stent ; SEPS ; self-expandable plastic stent
• 刊名：Gastrointestinal Endoscopy
• 出版年：2013
• 出版时间：January, 2013
• 年：2013
• 卷：77
• 期：1
• 页码：18-28
• 全文大小：1548 K

文摘

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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 ¡Ü .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.