Removal of self-expandable metallic Wallstents.
BACKGROUND
The self-expandable metallic stent is increasingly being used for management of malignant biliary strictures. In certain clinical situations, it also may be an alternative treatment for benign strictures. The ability to remove a metallic stent would be advantageous to the management of many biliary strictures, regardless of etiology.


METHODS
Stent removal was considered in 18 patients with either covered or uncovered Wallstents placed for biliary obstruction. Indications for placement were the following: unresectable cancer (10), chronic pancreatitis (3), benign biliary stricture (3), impacted stone (1), and papillary adenoma (1).


METHODS
Stent removal was successful in 17 patients. Mean follow-up after removal was 9 months. Thirteen removed stents were covered. Indications for removal were the following: occlusion (5), migration (3), facilitation of hemostasis (2), malposition (3), persistent cholestasis (1), stone extraction (1), stricture revision (1), gallbladder fossa abscess (1), and abdominal pain (1). Devices and techniques used for successful removal included a snare, an extraction balloon, and electrocoagulation combined with forceps.


CONCLUSIONS
Removal of uncovered Wallstents is difficult and typically requires a combination of techniques. Removal of covered Wallstents with a snare is relatively simple and safe, and can be followed immediately by corrective therapy. Insertion of a covered Wallstent should be considered as initial therapy when malignant biliary obstruction is suspected but unconfirmed.
Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville 22908-0708, USA.
Michel
M
Kahaleh
Jeffrey
J
Tokar
Tri
T
Le
Paul
P
Yeaton
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000628:therapy*; D001661:Biliary Tract Neoplasms / Q000150:complications; D003251:Constriction, Pathologic; D020878:Device Removal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents