Published online Oct 14, 2013. doi: 10.3748/wjg.v19.i38.6505
Revised: July 24, 2013
Accepted: August 20, 2013
Published online: October 14, 2013
Processing time: 116 Days and 20.5 Hours
A patient with stent embedding after placement of an esophageal stent for an esophagobronchial fistula was treated with an ST-E plastic tube inserted into the esophagus to the upper end of the stent using gastroscopy. The gastroscope was guided into the esophagus through the ST-E tube, and an alligator forceps was inserted into the esophagus through the ST-E tube alongside the gastroscope. Under gastroscopy, the stent wire was grasped with the forceps and pulled into the ST-E tube. When resistance was met during withdrawal, the gastroscope was guided further to the esophageal section where the stent was embedded. Biopsy forceps were guided through a biopsy hole in the gastroscope to the embedded stent to remove silicone membranes and connection threads linking the Z-shaped wire mesh. While the lower section of the Z-shaped stent was fixed by the biopsy forceps, the alligator forceps were used to pull the upper section of the metal wire until the Z-shaped metal loops elongated. The wire mesh of the stent was then removed in stages through the ST-E tube. Care was taken to avoid bleeding and perforation. Under the assistance of an ST-E plastic tube, an embedded esophageal metal stent was successfully removed with no bleeding or perforation. The patient experienced an uneventful recovery after surgery. Plastic tube-assisted gastroscopic removal of embedded metal stents can be minimally invasive, safe, and effective.
Core tip: A patient presented with a disordered stent structure as a result of failure of repeated attempts at gastroscopic removal. An ST-E tube was inserted into the esophagus. An alligator forceps was inserted into the ST-E tube alongside a gastroscope. The stent wire was gripped and pulled up into the tube. Biopsy forceps were inserted into the lower section of the stent through the biopsy hole to fix the stent, while the alligator forceps continued to be used to pull up the stent wire until the Z-shaped metal loops became elongated stripes. All the stent wire was removed through the ST-E tube.