Endoscopic Sub-Stent Dissection for Removal of Long-Term Embedded Esophageal Self-Expanding Metallic Stents

Self-expanding metallic stents (SEMS) have been extensively applied to manage esophageal disorders. The hyperplastic mucosal tissue induced by the stent can provide a good anchoring function but also make the stent removal difficult, especially after long-term placement. Here, we report a new technique, endoscopic sub-stent dissection, for removing the long-term embedded SEMS and assessing its safety and efficacy.

Patients with long-term embedded esophageal SEMS who underwent endoscopic sub-stent dissection between July 2018 and September 2024 were analyzed retrospectively. Demographic characteristics, procedure-related parameters, adverse events, and long-term outcomes were investigated.

A total of 16 patients with 17 embedded esophageal SEMS were included, where three patients had undergone a failed attempt using the stent-in-stent technique. Five patients (31.25%) were diagnosed with esophageal fistula, seven (43.75%) with stenosis, one (6.25%) with diverticulum, and three (18.75%) were placed for sealing the defects of endoscopic resection. Nine (52.94%) were partially covered SEMS (PCSEMS) and eight (47.06%) were fully covered SEMS (FCSEMS). The median stent retention time was 88.5 days (range, 28-1080). All embedded stents (100.0%) were successfully removed. The median procedure time was 26 min (range, 10-140). Procedure-related adverse events included one fever (6.25%) and one subcutaneous emphysema (6.25%). Three patients underwent outpatient surgery, and the median postoperative hospital stay was 3 days (range, 1-49).

Endoscopic sub-stent dissection is relatively safe and effective for removing long-term embedded esophageal SEMS. Further study with a larger sample size is warranted.