Metal biliary stent transection with over-the-scope clip removal system

Area of Science:

• Gastroenterology
• Endoscopy
• Interventional Endoscopy

Background:

• Uncovered self-expandable metal stents (UC-SEMSs) are crucial for unresectable pancreaticobiliary malignancies.
• Fraying of UC-SEMSs can lead to stent malfunction, ulceration, and perforation, necessitating intervention.
• Current methods like Argon Plasma Coagulation (APC) for trimming stents are cumbersome, time-consuming, and carry risks of tissue injury.

Purpose of the Study:

• To evaluate the safety and efficacy of a bipolar over-the-scope clip (OTSC) removal system for transecting distorted UC-SEMSs.
• To present a novel, off-label approach for managing complications associated with UC-SEMSs.

Main Methods:

• Two cases of distorted UC-SEMSs requiring transection were treated using a bipolar OTSC removal system.
• The system's electrical pulses were activated upon adequate metal contact with the stent.
• Compatibility and charging requirements of the paired generator were noted.

Main Results:

• The bipolar OTSC removal system successfully transected both distorted UC-SEMSs.
• No adverse events or tissue injury were observed in either case.
• The procedure allowed for subsequent necessary interventions.

Conclusions:

• The bipolar OTSC removal system provides a safe, effective, and potentially less cumbersome alternative to APC for transecting UC-SEMSs.
• This off-label use of the OTSC removal system demonstrates its versatility in managing complex stent-related issues.
• Further studies may be warranted to standardize this technique and explore its broader applications.