title: Safety and efficacy of argon plasma coagulation trimming of malpositioned and migrated biliary metal stents: a controlled study in the porcine model.
abstract: BACKGROUND
  Argon plasma coagulation (APC) has been used to trim uncovered Elgiloy stents, but the extent of thermal damage and bile duct injury is not known. The goal of this study was to evaluate the safety and efficacy of APC for this application.
  
  
  METHODS
  Eight Elgiloy (covered and uncovered) and four nitinol stents were deployed in the bile duct at ERCP in 12 anesthetized pigs. In nine pigs, the excess distal ends were trimmed in vivo using short bursts of APC. Three pigs served as controls. Bile ducts and stent specimens were then harvested for gross and histological examinations by a single-blinded pathologist.
  
  
  RESULTS
  APC effectively trimmed all the stents. Seven APC-treated bile ducts and three controls showed epithelial distortion consistent with pressure injury from stent expansion. Two APC-treated bile ducts showed mild thermal injury. The damage was superficial, extending to a maximum depth of 0.1 mm with rare foci involving subepithelial connective tissue.
  
  
  CONCLUSIONS
  APC at indicated settings effectively cuts covered and uncovered Elgiloy as well as nitinol stents, but can cause biliary epithelial injury secondary to conduction of heat and electrical energy. Proper technique and settings should be followed and short bursts of energy judiciously applied in order to minimize this danger.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Health Sciences Center, Denver, Colorado, USA.
authors.forename: Yang K
authors.initials: YK
authors.lastname: Chen
authors.forename: Vaman
authors.initials: V
authors.lastname: Jakribettuu
authors.forename: Erik W
authors.initials: EW
authors.lastname: Springer
authors.forename: Raj J
authors.initials: RJ
authors.lastname: Shah
authors.forename: Jeanine
authors.initials: J
authors.lastname: Penberthy
authors.forename: S Russell
authors.initials: SR
authors.lastname: Nash
mesh_terms: D000818:Animals; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation*; D004195:Disease Models, Animal; D004869:Equipment Safety; D005260:Female; D005548:Foreign-Body Migration / Q000473:pathology / Q000601:surgery*; D017075:Laser Coagulation / Q000379:methods*; D008297:Male; D011475:Prosthesis Failure; D015607:Stents; D013552:Swine; D016896:Treatment Outcome