Endoscopic trimming of metallic stents with the use of argon plasma.
BACKGROUND
The endoscopic placement of metallic stents for palliation of malignant obstruction of the GI or biliary tract is an established practice and as such is often applied. Use of these stents, however, has its problems. Stent migration may cause obstruction of the bowel lumen. Migration of a biliary stent into the contralateral duodenal wall may cause difficulty in gaining access to the biliary tract, as will the placement of a duodenal stent across the ampulla.


OBJECTIVE
We report on 6 patients in whom trimming of the metallic nitinol stent was performed.


METHODS
Single-center, retrospective case series.


METHODS
Secondary referral center.


METHODS
Of 6 patients included, 2 patients each had an uncovered duodenal stent, 2 had an uncovered biliary stent each, 1 had an uncovered colorectal stent, and 1 had a covered gastroduodenal stent.


METHODS
Under direct endoscopic vision, an argon plasma beam was used to cut self-expandable metallic stents, as appropriate.


METHODS
The main objective was relief of the obstruction to the bowel lumen or bile duct, facilitating successful passage of an endoscope or biliary canulation, respectively.


RESULTS
In all 5 patients with uncovered metallic stents, we were able to re-establish access to the obstructed bowel lumen or the biliary tree, as indicated. An attempt to tailor the length of a covered metallic gastroduodenal stent failed. No complications were observed and no hemorrhage or perforation occurred.


CONCLUSIONS
The study was limited by retrospective design and small sample size.


CONCLUSIONS
The endoscopic cutting and tailoring of an uncovered metallic prosthesis, by means of an argon plasma beam, is feasible, effective, and safe. Trimming of covered stents is not advocated.
Christiaens
Paul
P
Imelda Ziekenhuis Bonheiden, Keerbergen, Belgium.
Decock
Sofie
S
Buchel
Otto
O
Bulté
Katrien
K
Moons
Veerle
V
D'Haens
Geert
G
Van Olmen
Gust
G
D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D000497:Alloys; D001128:Argon; D001661:Biliary Tract Neoplasms / Q000601:surgery; D020878:Device Removal / Q000295:instrumentation; D004598:Electrosurgery / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D015607:Stents
D000497:Alloys; C013616:nitinol; D001128:Argon