Endoscopic laser fragmentation and removal of a nonremovable  metal esophageal stent for persistent dysphagia: a technical note.
BACKGROUND
Self-expanding metal stents are widely used in the palliation of esophageal diseases (Todd, N Engl J Med 344(22):1681-1687, 2001). The majority are inserted for end-stage malignancy and are not designed to be removed.


METHODS
We report the first recorded successful endoscopic removal of an "irremovable" stent by laser fragmentation after its placement became redundant. A 72-year-old man who had persistent dysphagia after esophageal stent insertion for Boerhaave's syndrome had his stent removed by Nd-YAG laser fragmentation at staged endoscopies.


RESULTS
The stent was removed in its entirety and the patients' symptoms resolved.


CONCLUSIONS
We describe a successful technique for the removal of a nonretrievable stent using laser fracture and endoscopic retrieval. This method of stent removal has not been previously reported.
Department of Upper GI Surgery, West Herts NHS Trust, Watford General Hospital, Vicarage Road, Watford WD18 0HB, UK. rosscoomber@hotmail.com
Ross S
RS
Coomber
Pranav H
PH
Patel
Anubhav
A
Dhir
Jeremy I
JI
Livingstone
D000368:Aged; D003680:Deglutition Disorders / Q000628:therapy*; D020878:Device Removal / Q000379:methods; D004939:Esophageal Perforation / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods*; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D008477:Mediastinal Diseases / Q000628:therapy*; D015607:Stents; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation