title: Difficult removal of fully covered self expandable metal stents (SEMS) for benign biliary strictures: the "SEMS in SEMS" technique.
abstract: BACKGROUND
  Removal of biliary Fully Covered Self Expandable Metal Stents can fail due to stent migration and/or hyperplastic ingrowth/overgrowth.
  
  
  METHODS
  A case series of 5 patients with benign biliary strictures (2 post-cholecystectomy, 2 following liver transplantation and 1 related to chronic pancreatitis) is reported. The biliary stricture was treated by temporary insertion of Fully Covered Self Expandable Metal Stents. Stent removal failed due to proximal stent migration and/or overgrowth. Metal stent removal was attempted a few weeks after the insertion of another Fully Covered Metal Stent into the first one.
  
  
  RESULTS
  The inner Fully Covered Self Expandable Metal Stent compressed the hyperplastic tissue, leading to the extraction of both the stents in all cases. Two complications were reported as a result of the attempt to stents removal (mild pancreatitis and self-limited haemobilia).
  
  
  CONCLUSIONS
  In the present series, the "SEMS in SEMS" technique revealed to be effective when difficulties are encountered during Fully Covered Self Expandable Metal Stents removal.
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy. Electronic address: andrea.tringali@rm.unicatt.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tringali
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: Blero
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Ivo
authors.initials: I
authors.lastname: Boškoski
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Familiari
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Perri
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Devière
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
mesh_terms: D000368:Aged; D000497:Alloys; D001649:Bile Duct Diseases / Q000209:etiology / Q000628:therapy*; D001652:Bile Ducts / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D020878:Device Removal / Q000379:methods*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications; D011475:Prosthesis Failure; D015607:Stents
chemical_list: D000497:Alloys; C013616:nitinol
keywords: Benign biliary stricture; Fully covered SEMS; Ingrowth; Overgrowth; Self Expandable Metal Stent; Stent migration