Endoscopic trimming of an embedded distally migrated metallic rectal stent with argon plasma coagulation

There is little experience regarding the use of argon plasma coagulation (APC) to trim malpositioned or migrated, endoscopic, metallic, self-expanding, colorectal stents. We report a case of a distally migrated, uncovered rectal stent complicated with several ulcerations because of impaction against the rectal wall and embedment within the healthy mucosa distal to the neoplasm. Endoscopic en bloc removal was not possible because of diffuse tumoral ingrowth. By using a second generation APC device (60 W, 0.6 L/min), the stent was trimmed allowing access to the back wall, which was tailored after digging up the embedded wires with gentle traction of the stent. Complete extraction of the protruding end of the stent by a 2.5 cm, fully covered pseudoepithelization tissue, was carried out through a flexible overtube. This is the first report of APC endoscopic transection of a long embedded segment from a distally migrated colorectal stent.