Exceptionally prolonged retention of a silicone-covered esophageal stent before TIPS for refractory variceal...

Refractory esophageal variceal bleeding (REVB) in patients with cirrhosis is associated with high mortality. Self-expanding metal stents (SEMS) serve as a salvage therapeutic option. However, data regarding their prolonged use as a bridge to transjugular intrahepatic portosystemic shunt (TIPS) remain limited. We report a case in which REVB was managed with prolonged SEMS placement before TIPS.

A 72-year-old female with decompensated cirrhosis presented with acute hematemesis. After failure of endoscopic injection sclerotherapy and band ligation to control active bleeding from a ruptured esophageal varix, a fully covered SEMS was successfully deployed. The patient declined the scheduled stent removal and was subsequently followed conservatively. TIPS was performed 387 days after stent placement, followed by a successful stent retrieval. Clinical outcomes, including rebleeding episodes and procedure-related complications, were recorded throughout follow-up until July 26, 2026.

Immediate hemostasis was achieved following SEMS deployment. During the 387-day indwelling period, the patient developed intermittent acid regurgitation, retrosternal discomfort, and endoscopic evidence of mucosal ulceration and granulation tissue at the stent site. The stent was successfully removed after TIPS, and follow-up endoscopy revealed complete resolution of the esophageal varices. The patient remained free of recurrent bleeding till the last follow-up. However, two episodes of hepatic encephalopathy occurred after TIPS.

This case suggests that successful removal of a fully covered esophageal SEMS may remain technically feasible even after an exceptionally prolonged retention period. Nonetheless, this observation should not be interpreted as support for routine prolonged stent placement, which lies outside current guideline recommendations and may entail substantial risks.