Endoscopic removal and trimming of distal self-expandable metallic biliary stents

Table 1 Characteristics of patients

	Total	Stent removal	Stent trimming
No. patients	27	19	81
Sex (male/female)	17/10	13/6	4/41
Mean age, yr, (range)	68.1 (43-91)	66.9 (43-91)	70.9 (54-90)
Etiology of biliary strictures
Pancreatic carcinoma	17	12	5
Biliary ductal carcinoma	3	2	1
IPMC	1	0	1
Lymph node metastasis2	1	0	1
Chronic pancreatitis	2	2	0
MFP	2	2	0
AIP	1	1	0
Type of SEMS
Uncovered Wallstent	2	1	1
Covered SEMS	25	18	7
Covered Wallstent (Partially covered type)	7	4	3
Niti-S Biliary ComVi Stent (Partially covered type)	2	1	1
Niti-S Biliary ComVi Stent (Fully covered type)	14	11	3
Niti-S Biliary Covered Stent with removal suture	2	2	0

¹Including 3 cases with impossible stent removal;

²Due to cancer of the uterine body. IPMC: Intraductal papillary mucinous carcinoma; MFP: Mass-forming pancreatitis; AIP: Autoimmune pancreatitis; SEMS: Self-expandable metallic stent.

Table 2 Outcome of removal of metallic stent

No. of case	Disease	Type of SEMS	Duration of stent placement (d)	Outcome	Additional procedures
1	Pancreatic ca.	Uncovered Wallstent	180	Unsuccess	Trimming
2	Pancreatic ca.	Niti-S Biliary ComVi Stent (Partially covered type)	114	Unsuccess	Trimming
3	Pancreatic ca.	Niti-S Biliary ComVi Stent (Fully covered type)	280	Unsuccess	Trimming
4	Bile duct ca.	Niti-S Biliary ComVi Stent (Fully covered type)	81	Unsuccess	Stent in stent
5	Bile duct ca.	Niti-S Biliary ComVi Stent (Fully covered type)	219	Success	New SEMS
6	Pancreatic ca	Niti-S Biliary ComVi Stent (Fully covered type)	232	Success	New SEMS
7	Pancreatic ca.	Covered Wallstent (Partially covered type)	15	Success	New SEMS
8	Pancreatic ca.	Covered Wallstent (Partially covered type)	78	Success	New SEMS
9	Pancreatic ca.	Niti-S Biliary ComVi Stent (Fully covered type)	155	Success	New SEMS
10	Pancreatic ca.	Niti-S Biliary ComVi Stent (Fully covered type)	32	Success	New SEMS
11	Pancreatic ca.	Niti-S Biliary ComVi Stent (Fully covered type)	98	Success	New SEMS
12	Pancreatic ca.	Niti-S Biliary ComVi Stent (Fully covered type)	50	Success	New SEMS
13	Pancreatic ca.	Niti-S Biliary ComVi Stent (Fully covered type)	157	Success	New SEMS
14	Pancreatic ca.	Niti-S Biliary ComVi Stent (Fully covered type)	75	Success	New SEMS
15	AIP	Niti-S Biliary ComVi Stent (Fully covered type)	8	Success	None
16	MFP	Covered Wallstent (Partially covered type)	100	Success	New SEMS
17	MFP	Covered Wallstent (Partially covered type)	176	Unsuccess	None
18	CP	Niti-S Biliary Covered Stent with removal suture	33	Success	New SEMS
19	CP	Niti-S Biliary Covered Stent with removal suture	77	Success	None

ca.: Carcinoma; CP: Chronic pancreatitis; SEMS: Self-expandable metallic stent; MFP: Mass-forming pancreatitis; AIP: Autoimmune pancreatitis.

Table 3 Outcome of stent trimming

No. of case	Disease	SEMS	Procedural time (min)	Additional procedure after trimming
1	Pancreatic ca.	Uncovered Wallstent	12	None
2	Pancreatic ca.	Niti-S Biliary ComVi Stent	11	Stent in stent
3	Pancreatic ca.	Niti-S Biliary ComVi Stent	14	Stent in stent
4	Pancreatic ca.	Covered Wallstent	14	None
5	Pancreatic ca.	Covered Wallstent	16	None
6	Bile duct ca.	Niti-S Biliary ComVi Stent	12	None
7	IPMC	Covered Wallstent	12	None
8	Lymph node metastasis1	Niti-S Biliary ComVi Stent	15	None

Argon plasma coagulation setting: 60-80 W, Coagulation mode 1.5 L/min.

¹Due to cancer of the uterine body. ca.: Carcinoma; IPMC: Intraductal papillary mucinous carcinoma; SEMS: Self-expandable metallic stent.

Table 4 Review of stent removal

Author	Total No. of stent/patient	Type of SEMS	n	Disease	Mean duration of indwelling stent (range)	Success rate (%)
Kahaleh et al[7]	18/18	Uncovered Wallstent	2	BBS	(1-4 mo)	2/2 (100)
		Uncovered Wallstent	2	MBS	(10-11 mo)	2/2 (100)
		Covered Wallstent	6	BBS	4.7 mo (1-10 mo)	6/6 (100)
		Covered Wallstent	8	MBS	4.5 mo (1-16 mo)	7/8 (87.5)
Familiari et al[8]	39/29	Covered Wallstent	12			12/12 (100)
		Shim-Hanarostent	10			9/10 (90)
		Uncovered Wallstent	10	MBS (26)	7.5 mo	5/10 (50)
		Niti-S Biliary Stent	4	BBS (3)	(5 d-16 mo)	3/4 (75)
		Sinus-Superflex Stent	2			0/2 (0)
		Zilver Stent	1			0/1 (0)
Shin et al[9]	30/30	Uncovered Wallstent	5	MBS	Uncovered SEMSs	0/5 (0)
		Zilver Stent	3	MBS	121.4 ± 45.4 d	0/3 (0)
		Covered Wallstent	21	MBS	Covered SEMSs	18/21 (85.7)
		Covered Wallstent	1	BBS	129.7 ± 95.4 d	1/1 (100)
Kahaleh et al[15]	65/65	Covered Wallstent	65	BBS	4 mo (1-28 mo)	65/65 (100)
Present study	19/19	Covered Wallstent	2	MBS	46.5 d (15-78 d)	2/2 (100)
		Covered Wallstent	2	BBS	(100-176 d)	1/2 (50)
		Uncovered Wallstent	1	MBS	180 d	0/1 (0)
		Niti-S Biliary ComVi Stent	11	MBS	136 d (32-280 d)	8/11 (72.7)
		Niti-S Biliary ComVi Stent	1	BBS	8 d	1/1 (100)
		Niti-S Biliary Covered Stent with removal suture	2	BBS	55 d (33-77 d)	2/2 (100)

SEMS: Self-expandable metallic stent; BBS: Benign biliary strictures; MBS: Malignant biliary strictures.

Table 5 Review of biliary stent trimming

Auther	Total No. of cases	SEMS	No. of case	Setting of APC system	Procedural time	Success rate
Demarquay et al[4]	3	Uncovered Wallstent	3	85 W, coag. 0.8 L/min	NA	100% (3/3)
Vanbiervliet et al[10]	24	Uncovered Wallstent	23	70-80 W, coag. 0.8 L/min	< 30 min	95.7% (22/23)
		Covered Wallstent	1	70-80 W, coag. 0.8 L/min	< 30 min	0% (0/1)
Guda et al[11]	2	Uncovered Wallstent	1	80 W, coag. 2.0 L/min	NA	100% (1/1)
		Uncovered Wallstent	1	60 W, coag. 2.0 L/min	NA	100% (1/1)
Rerknimitr et al[12]	2	Covered Wallstent	1	60 W, coag. 0.8 L/min	20 min	100% (1/1)
		Uncovered Wallstent	1	70 W, coag. 0.8 L/min	NA	100% (1/1)
Christiaens et al[13]	2	Uncovered SEMS (nitinol)	1	60 W, coag. 1.8 L/min	NA	100% (1/1)
		Uncovered SEMS (nitinol)	1	60 W, coag. 1.8 L/min	NA	100% (1/1)
Present study	8	Covered Wallstent	3	60-80 W, coag. 1.5 L/min	< 20 min	100% (3/3)
		Uncovered Wallstent	1	60-80 W, coag. 1.5 L/min	12 min	100% (1/1)
		Niti-S Biliary ComVi Stent	4	60-80 W, coag. 1.5 L/min	< 20 min	100% (4/4)

NA: Not available; SEMS: Self-expandable metallic stent; APC: Argon plasma coagulation; coag.: Coagulation mode.