title: Endoscopic removal and trimming of distal self-expandable metallic biliary stents.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of endoscopic removal and trimming of self-expandable metallic stents (SEMS).
  
  
  METHODS
  All SEMS had been placed for distal biliary strictures. Twenty-seven endoscopic procedures were performed in 19 patients in whom SEMS (one uncovered and 18 covered) removal had been attempted, and 8 patients in whom stent trimming using argon plasma coagulation (APC) had been attempted at Tokyo Medical University Hospital. The APC settings were: voltage 60-80 W and gas flow at 1.5 L/min.
  
  
  RESULTS
  The mean stent indwelling period for all patients in whom stent removal had been attempted was 113.7 ± 77.6 d (range, 8-280 d). Of the 19 patients in whom removal of the SEMS had been attempted, the procedure was successful in 14 (73.7%) without procedure-related adverse events. The indwelling period in the stent removable group was shorter than that in the unremovable group (94.9 ± 71.5 d vs 166.2 ± 76.2 d, P = 0.08). Stent trimming was successful for all patients with one minor adverse event consisting of self-limited hemorrhage. Trimming time ranged from 11 to 16 min.
  
  
  CONCLUSIONS
  Although further investigations on larger numbers of cases are necessary to accumulate evidence, the present data suggested that stent removal and stent trimming is feasible and effective for stent-related complications.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, 160-0023, Japan. ishiken@tokyo-med.ac.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ishii
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sofuni
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Toshio
authors.initials: T
authors.lastname: Kurihara
authors.forename: Shujiro
authors.initials: S
authors.lastname: Tsuji
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Ikeuchi
authors.forename: Junko
authors.initials: J
authors.lastname: Umeda
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
authors.forename: Akihiko
authors.initials: A
authors.lastname: Tsuchida
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057908:Argon Plasma Coagulation / Q000706:statistics & numerical data*; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery; D001659:Biliary Tract / Q000473:pathology*; D003251:Constriction, Pathologic / Q000601:surgery; D020878:Device Removal; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents