Fluoroscopic removal of retrievable self-expandable metal stents in patients with malignant oesophageal strictures: Experience with a non-endoscopic removal system

Pyeong Hwa Kim; Ho Young Song; Jung Hoon Park; Wei Zhong Zhou; Han Kyu Na; Young Chul Cho; Eun Jung Jun; Jun Ki Kim; Guk Bae Kim

doi:10.1007/s00330-016-4431-2

Fluoroscopic removal of retrievable self-expandable metal stents in patients with malignant oesophageal strictures: Experience with a non-endoscopic removal system

Pyeong Hwa Kim, Ho Young Song, Jung Hoon Park, Wei Zhong Zhou, Han Kyu Na, Young Chul Cho, Eun Jung Jun, Jun Ki Kim, Guk Bae Kim

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Objectives: To evaluate clinical outcomes of fluoroscopic removal of retrievable self-expandable metal stents (SEMSs) for malignant oesophageal strictures, to compare clinical outcomes of three different removal techniques, and to identify predictive factors of successful removal by the standard technique (primary technical success). Methods: A total of 137 stents were removed from 128 patients with malignant oesophageal strictures. Primary overall technical success and removal-related complications were evaluated. Logistic regression models were constructed to identify predictive factors of primary technical success. Results: Primary technical success rate was 78.8 % (108/137). Complications occurred in six (4.4 %) cases. Stent location in the upper oesophagus (P=0.004), stricture length over 8 cm (P=0.030), and proximal granulation tissue (P<0.001) were negative predictive factors of primary technical success. If granulation tissue was present at the proximal end, eversion technique was more frequently required (P=0.002). Conclusions: Fluoroscopic removal of retrievable SEMSs for malignant oesophageal strictures using three different removal techniques appeared to be safe and easy. The standard technique is safe and effective in the majority of patients. The presence of proximal granulation tissue, stent location in the upper oesophagus, and stricture length over 8 cm were negative predictive factors for primary technical success by standard extraction and may require a modified removal technique. Key Points: • Fluoroscopic retrievable SEMS removal is safe and effective. • Standard removal technique by traction is effective in the majority of patients. • Three negative predictive factors of primary technical success were identified. • Caution should be exercised during the removal in those situations. • Eversion technique is effective in cases of proximal granulation tissue.

Original language	English (US)
Pages (from-to)	1257-1266
Number of pages	10
Journal	European Radiology
Volume	27
Issue number	3
DOIs	https://doi.org/10.1007/s00330-016-4431-2
State	Published - Mar 1 2017
Externally published	Yes

Keywords

Device removal
Fluoroscopy
Oesophageal neoplasms
Self expandable metallic stents
Stents

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

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10.1007/s00330-016-4431-2

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@article{3f665dbbf4324ddca85e0ccc7872ffb1,

title = "Fluoroscopic removal of retrievable self-expandable metal stents in patients with malignant oesophageal strictures: Experience with a non-endoscopic removal system",

abstract = "Objectives: To evaluate clinical outcomes of fluoroscopic removal of retrievable self-expandable metal stents (SEMSs) for malignant oesophageal strictures, to compare clinical outcomes of three different removal techniques, and to identify predictive factors of successful removal by the standard technique (primary technical success). Methods: A total of 137 stents were removed from 128 patients with malignant oesophageal strictures. Primary overall technical success and removal-related complications were evaluated. Logistic regression models were constructed to identify predictive factors of primary technical success. Results: Primary technical success rate was 78.8 % (108/137). Complications occurred in six (4.4 %) cases. Stent location in the upper oesophagus (P=0.004), stricture length over 8 cm (P=0.030), and proximal granulation tissue (P<0.001) were negative predictive factors of primary technical success. If granulation tissue was present at the proximal end, eversion technique was more frequently required (P=0.002). Conclusions: Fluoroscopic removal of retrievable SEMSs for malignant oesophageal strictures using three different removal techniques appeared to be safe and easy. The standard technique is safe and effective in the majority of patients. The presence of proximal granulation tissue, stent location in the upper oesophagus, and stricture length over 8 cm were negative predictive factors for primary technical success by standard extraction and may require a modified removal technique. Key Points: • Fluoroscopic retrievable SEMS removal is safe and effective. • Standard removal technique by traction is effective in the majority of patients. • Three negative predictive factors of primary technical success were identified. • Caution should be exercised during the removal in those situations. • Eversion technique is effective in cases of proximal granulation tissue.",

keywords = "Device removal, Fluoroscopy, Oesophageal neoplasms, Self expandable metallic stents, Stents",

author = "Kim, {Pyeong Hwa} and Song, {Ho Young} and Park, {Jung Hoon} and Zhou, {Wei Zhong} and Na, {Han Kyu} and Cho, {Young Chul} and Jun, {Eun Jung} and Kim, {Jun Ki} and Kim, {Guk Bae}",

note = "Funding Information: The scientific guarantor of this publication is Ho-Young Song, M.D. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and future Planning (NRF-2014R1A2A2A04006562). No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Approval from the institutional animal care committee was not required because our study is not on animal subjects. Our study subjects or cohorts have not been reported. Publisher Copyright: {\textcopyright} 2016, European Society of Radiology.",

year = "2017",

month = mar,

day = "1",

doi = "10.1007/s00330-016-4431-2",

language = "English (US)",

volume = "27",

pages = "1257--1266",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer Verlag",

number = "3",

}

TY - JOUR

T1 - Fluoroscopic removal of retrievable self-expandable metal stents in patients with malignant oesophageal strictures

T2 - Experience with a non-endoscopic removal system

AU - Kim, Pyeong Hwa

AU - Song, Ho Young

AU - Park, Jung Hoon

AU - Zhou, Wei Zhong

AU - Na, Han Kyu

AU - Cho, Young Chul

AU - Jun, Eun Jung

AU - Kim, Jun Ki

AU - Kim, Guk Bae

N1 - Funding Information: The scientific guarantor of this publication is Ho-Young Song, M.D. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and future Planning (NRF-2014R1A2A2A04006562). No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Approval from the institutional animal care committee was not required because our study is not on animal subjects. Our study subjects or cohorts have not been reported. Publisher Copyright: © 2016, European Society of Radiology.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Objectives: To evaluate clinical outcomes of fluoroscopic removal of retrievable self-expandable metal stents (SEMSs) for malignant oesophageal strictures, to compare clinical outcomes of three different removal techniques, and to identify predictive factors of successful removal by the standard technique (primary technical success). Methods: A total of 137 stents were removed from 128 patients with malignant oesophageal strictures. Primary overall technical success and removal-related complications were evaluated. Logistic regression models were constructed to identify predictive factors of primary technical success. Results: Primary technical success rate was 78.8 % (108/137). Complications occurred in six (4.4 %) cases. Stent location in the upper oesophagus (P=0.004), stricture length over 8 cm (P=0.030), and proximal granulation tissue (P<0.001) were negative predictive factors of primary technical success. If granulation tissue was present at the proximal end, eversion technique was more frequently required (P=0.002). Conclusions: Fluoroscopic removal of retrievable SEMSs for malignant oesophageal strictures using three different removal techniques appeared to be safe and easy. The standard technique is safe and effective in the majority of patients. The presence of proximal granulation tissue, stent location in the upper oesophagus, and stricture length over 8 cm were negative predictive factors for primary technical success by standard extraction and may require a modified removal technique. Key Points: • Fluoroscopic retrievable SEMS removal is safe and effective. • Standard removal technique by traction is effective in the majority of patients. • Three negative predictive factors of primary technical success were identified. • Caution should be exercised during the removal in those situations. • Eversion technique is effective in cases of proximal granulation tissue.

AB - Objectives: To evaluate clinical outcomes of fluoroscopic removal of retrievable self-expandable metal stents (SEMSs) for malignant oesophageal strictures, to compare clinical outcomes of three different removal techniques, and to identify predictive factors of successful removal by the standard technique (primary technical success). Methods: A total of 137 stents were removed from 128 patients with malignant oesophageal strictures. Primary overall technical success and removal-related complications were evaluated. Logistic regression models were constructed to identify predictive factors of primary technical success. Results: Primary technical success rate was 78.8 % (108/137). Complications occurred in six (4.4 %) cases. Stent location in the upper oesophagus (P=0.004), stricture length over 8 cm (P=0.030), and proximal granulation tissue (P<0.001) were negative predictive factors of primary technical success. If granulation tissue was present at the proximal end, eversion technique was more frequently required (P=0.002). Conclusions: Fluoroscopic removal of retrievable SEMSs for malignant oesophageal strictures using three different removal techniques appeared to be safe and easy. The standard technique is safe and effective in the majority of patients. The presence of proximal granulation tissue, stent location in the upper oesophagus, and stricture length over 8 cm were negative predictive factors for primary technical success by standard extraction and may require a modified removal technique. Key Points: • Fluoroscopic retrievable SEMS removal is safe and effective. • Standard removal technique by traction is effective in the majority of patients. • Three negative predictive factors of primary technical success were identified. • Caution should be exercised during the removal in those situations. • Eversion technique is effective in cases of proximal granulation tissue.

KW - Device removal

KW - Fluoroscopy

KW - Oesophageal neoplasms

KW - Self expandable metallic stents

KW - Stents

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ER -

Fluoroscopic removal of retrievable self-expandable metal stents in patients with malignant oesophageal strictures: Experience with a non-endoscopic removal system

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