title: Endoscopic removal of biliary self-expandable metallic stents: a prospective study.
abstract: OBJECTIVE
  The transpapillary endoscopic insertion of self-expandable metallic stents (SEMSs) has been widely used for the palliation of unresectable malignant biliary obstruction. We attempted the endoscopic removal of malfunctioning SEMSs. The aim of this study was to assess the feasibility and safety of the endoscopic removal of SEMSs by comparing the results between removal of covered and uncovered SEMSs.
  
  
  METHODS
  30 patients with a malfunctioning biliary SEMS prospectively underwent an attempt at endoscopic removal of the biliary SEMS over a 2-year period. Removal of the malfunctioning SEMS was done with a therapeutic duodenoscope (ED-450XT5 or TJF-240), using a rat-tooth forceps. Of the 30 SEMS used, 22 were silicone-covered Wallstents, while eight were uncovered SEMSs including five uncovered Wallstents and three Zilver stents. The time for an attempt at each endoscopic removal was limited to 15 minutes in a single endoscopic procedure session.
  
  
  RESULTS
  The covered SEMSs were easily removed in 19 out of 22 patients (86.4 %), whereas none of the eight uncovered SEMSs (0 %) could be removed. The only factor predicting successful stent removal was the presence of a stent covering ( P = 0.000). There was no morbidity or mortality related to endoscopic removal of malfunctioning stents.
  
  
  CONCLUSIONS
  In contrast to uncovered biliary SEMSs, in most cases malfunctioning covered biliary SEMSs can be easily and safely removed endoscopically using a rat-tooth forceps.
authors.affiliation: Department of Internal Medicine, East-West Neo Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.
authors.forename: H P
authors.initials: HP
authors.lastname: Shin
authors.forename: M-H
authors.initials: MH
authors.lastname: Kim
authors.forename: S W
authors.initials: SW
authors.lastname: Jung
authors.forename: J C
authors.initials: JC
authors.lastname: Kim
authors.forename: E K
authors.initials: EK
authors.lastname: Choi
authors.forename: J
authors.initials: J
authors.lastname: Han
authors.forename: S S
authors.initials: SS
authors.lastname: Lee
authors.forename: D W
authors.initials: DW
authors.lastname: Seo
authors.forename: S K
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000368:Aged; D001660:Biliary Tract Diseases / Q000473:pathology; D002758:Cholangiography; D020698:Duodenoscopes / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015607:Stents