title: Stent-in-stent technique for removal of embedded partially covered self-expanding metal stents.
abstract: Removal of embedded partially covered self-expanding metal stents (PCSEMS) is associated with an increased risk of adverse events compared with removal of fully covered self-expanding stents (FCSES) due to tissue ingrowth. Successful removal of embedded PCSEMS has been described by the stent-in-stent (SIS) technique.
  
  
  
  To report the first US experience from three high-volume quaternary care centers on the safety and efficacy of the SIS technique for removal of embedded PCSEMS.
  
  
  
  Retrospective study of outcomes for consecutive patients who underwent the SIS for removal of embedded PCSEMS over a 5-year period.
  
  
  
  Twenty-seven embedded PCSEMS were successfully removed using the SIS technique (100 %) from 25 patients (11 males), median age 65 (range 37-80). All stents were successfully removed in one endoscopic session (no repeat SIS procedures were required for persistently embedded stents). The embedded PCSEMS had been in situ for a median of 76 days (range 26-501). Median SIS dwell time (FCSES in situ of PCSEMS) was 13 days (interquartile range 8-16 days; range 4-212 days). One adverse event (self-limited bleeding) occurred during a median follow-up period of 3 months (range 1-32). No patients died, required surgery, or had long-term disability due to adverse events attributed to the SIS technique. Twelve patients required additional interventions following SIS procedure for persistence or recurrence of the underlying pathology.
  
  
  
  When performed by experienced endoscopists, safe and effective removal of embedded PCSEMS can be achieved via the SIS technique.
authors.affiliation: Gastroenterology, Vanderbilt University, Nashville, TN, USA.
authors.forename: Tomas
authors.initials: T
authors.lastname: DaVee
authors.affiliation: Gastroenterology, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Shayan
authors.initials: S
authors.lastname: Irani
authors.affiliation: Gastroenterology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Cadman L
authors.initials: CL
authors.lastname: Leggett
authors.affiliation: Gastroenterology, Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Manuel
authors.initials: M
authors.lastname: Berzosa Corella
authors.affiliation: Gastroenterology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Karina V
authors.initials: KV
authors.lastname: Grooteman
authors.affiliation: Gastroenterology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Louis-Michel
authors.initials: LM
authors.lastname: Wong Kee Song
authors.affiliation: Gastroenterology, Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
authors.affiliation: Gastroenterology, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kozarek
authors.affiliation: Gastroenterology, University of North Carolina, Chapel Hill, NC, USA. todd_baron@med.unc.edu.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal / Q000379:methods*; D004937:Esophageal Fistula / Q000601:surgery; D004940:Esophageal Stenosis / Q000601:surgery; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects*
keywords: Advanced therapeutic endoscopy; Anastomotic perforation or leak; Embedded stents; Endoscopic stents; Esophageal cancer; Esophageal strictures