title: A multicenter analysis of safety and outcome of removal of a fully covered self-expandable metal stent during ERCP.
abstract: BACKGROUND
  Fully covered self-expandable metal stents (FCSEMSs) have been used for palliation of both malignant and benign biliary strictures. Limited data are available about safety and outcome of endoscopic removal of these stents.
  
  
  OBJECTIVE
  To evaluate safety and efficacy of endoscopic removal of FCSEMSs.
  
  
  METHODS
  Retrospective review of patients who underwent endoscopic removal of Viabil FCSEMSs.
  
  
  METHODS
  Four centers with experience in using FCSEMSs.
  
  
  METHODS
  Thirty-seven patients who had stents endoscopically removed.
  
  
  METHODS
  ERCP with endoscopic removal of FCSEMSs.
  
  
  METHODS
  Feasibility, safety, and complications associated with endoscopic removal of FCSEMS.
  
  
  RESULTS
  All 37 stent removal attempts were successful and were achieved without difficulty. Indwelling stent-related complications occurred in 4 of 37 patients, including secondary strictures in 3 and minor bile leak in 1. Two of 3 secondary strictures occurred at the distal stent margin of oversized intraductal stents, and another stricture occurred at a proximal stent margin of an oversized transpapillary stent. One case of minor confined intratumoral bile leak also occurred in a patient with metastatic urothelial cancer of the bile duct. All of these cases were successfully treated with repeat stenting and resolved without sequelae. No free perforations or significant bleeding occurred.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  Endoscopic removal of Viabil FCSEMSs placed for benign or malignant conditions is feasible and easily accomplished. Secondary strictures may be found at the time of stent removal or with a delayed presentation in patients with oversized stents who may require repeat stent placement.
authors.affiliation: University of Arizona, Tucson, Arizona, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Kasher
authors.forename: James G
authors.initials: JG
authors.lastname: Corasanti
authors.forename: Paul R
authors.initials: PR
authors.lastname: Tarnasky
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.forename: Evan
authors.initials: E
authors.lastname: Fogel
authors.forename: John
authors.initials: J
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000209:etiology*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology; D020878:Device Removal / Q000009:adverse effects*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome