埋め込み金属胆道ステント除去における救済法としてのステントインステント手技の有効性
Yasuhiro Komori1,2, Susumu Hijioka1, Yoshikuni Nagashio1
1Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Tokyo Japan.
Objectives:
Self-expandable metal stents (SEMS) may become embedded because of tissue hyperplasia or tumor ingrowth, making their removal challenging. The stent-in-stent (SIS) method, which involves placing another SEMS inside to compress the tissue and aid removal, is a known rescue approach for stent removal. However, its efficacy across anatomical routes, optimal timing of removal, and predictors of difficult stent removal remain unclear.
Methods:
We retrospectively reviewed 17 patients treated between April 2018 and May 2025. Embedded stents were placed via the transpapillary route, endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS), or choledochojejunal anastomosis. Technical success rates and adverse events were evaluated.
Results:
The overall technical success rate was 76.5%, with rates of 80.0%, 100%, and 33.3% for the transpapillary route, EUS-HGS, and choledochojejunal anastomosis, respectively. Three of the four failures occurred when removal was attempted within 4 weeks of the second stent placement. Stent removal was successful in 100% of the hyperplasia cases but in 60% of the ingrowth cases. Cholecystitis occurred in one case after the second stent placement.
Conclusions:
The SIS method is feasible for the transpapillary route and EUS-HGS but may show limited efficacy in choledochojejunal anastomosis. Stent removal 4 weeks after the second stent placement improves the success rate. The SIS method may be less effective in cases of malignant ingrowth.
