Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Am J Gastroenterol. 2011 Feb;106(2):286-93. doi: 10.1038/ajg.2010.394. Epub 2010 Oct 12.
Partially covered self-expanding metal stents (SEMSs) are regularly used for malignant and occasionally for benign esophageal disorders. Safe removal of these stents can be challenging due to embedding of the uncovered stent ends. Our aim is to report the results of removal of embedded, partially covered SEMSs by induction of pressure necrosis using the stent-in-stent technique.
Consecutive patients referred to three endoscopy units in 2007-2009, treated by the stent-in-stent technique, were reviewed. The partially covered SEMSs were inserted for malignant (n=3) or benign (n=16) conditions and were left in situ for a median of 42 days (14-189). When SEMSs were found to be embedded, a fully covered self-expanding plastic stent (SEPS) or fully covered SEMS was placed inside the partially uncovered SEMS. Subsequent removal of both stents was planned after a period of 10-14 days.
In total, 23 stent-in-stent procedures were performed in 19 patients (10 males). Placement of a fully covered stent (SEPS: n=9 and SEMS: n=14) was technically successful in all patients. In 21 of 23 (91%) procedures, both stents were successfully removed in one procedure after a median of 12 days (5-18). In two patients, a repeat stent-in-stent procedure was needed for persistent embedding of the partially uncovered SEMSs. One (5%) procedure was complicated by severe bleeding, which could be treated endoscopically. In seven (36%) patients, the initial disorder had resolved after stent removal and no further endoscopic interventions were needed. Two (10%) patients were treated with chemoradiation or surgery for esophageal cancer after stent removal. In 10 (53%) patients, a repeat endoscopic intervention was required during follow-up because of progressive dysphagia or a persisting leak or fistula.
The stent-in-stent technique is safe and effective for the removal of partially covered SEMSs that are embedded in the esophageal wall.
部分覆盖自膨式金属支架（SEMS）常用于治疗恶性疾病，偶尔也用于良性食管疾病。由于未覆盖的支架末端嵌入，安全取出这些支架可能具有挑战性。我们的目的是报告使用支架内支架技术通过诱导压力坏死来取出嵌入的部分覆盖 SEMS 的结果。
回顾了 2007 年至 2009 年期间在三个内镜单位就诊的连续患者，他们接受了支架内支架技术治疗。插入部分覆盖的 SEMS 用于治疗恶性疾病（n=3）或良性疾病（n=16），中位时间为 42 天（14-189）。当发现 SEMS 嵌入时，将完全覆盖的自膨式塑料支架（SEPS）或完全覆盖的 SEMS 放置在部分未覆盖的 SEMS 内。在 10-14 天后计划同时取出两个支架。
总共在 19 名患者（10 名男性）中进行了 23 次支架内支架手术。在所有患者中，完全覆盖支架（SEPS：n=9 和 SEMS：n=14）的放置均技术上成功。在 23 次手术中的 21 次（91%）中，在中位时间为 12 天（5-18）后，一次手术成功地同时取出了两个支架。在两名患者中，需要重复进行支架内支架手术以去除部分未覆盖的 SEMS 持续嵌入。一例（5%）手术因严重出血而复杂化，但可通过内镜治疗。在 7 例（36%）患者中，支架取出后初始疾病得到缓解，无需进一步内镜干预。两名（10%）患者在支架取出后接受放化疗或手术治疗食管癌。在 10 例（53%）患者中，在随访期间需要进行重复内镜干预，因为进行性吞咽困难或持续存在的漏或瘘。
支架内支架技术对于取出嵌入食管壁的部分覆盖 SEMS 是安全有效的。
