Duodenal covered self-expandable metal stents (C-SEMSs) are designed with stent mesh
to prevent tumor ingrowth [1]. However, stent migration is a major adverse event associated with C-SEMS, occurring
in 8 % – 25 % of cases [2]
[3]. In some cases, migrated stents exit via the rectum or remain in the body without
complications [4]. However, when stent migration causes an intestinal obstruction, surgical removal
is required [5]. To our knowledge, there are few reports of migrated SEMS removal via peroral endoscopy.
Here, we outline a case of successful removal of a migrated duodenal C-SEMS using
enteroscopy through an expanded second duodenal SEMS ([Video 1]).
Video 1 Successful peroral removal of a migrated self-expandable metal stent using an enteroscope.
(Yellow triangle, stent; white triangle, obstruction.)
An 80-year-old man diagnosed with a malignant duodenal obstruction caused by pancreatic
cancer underwent endoscopic duodenal C-SEMS placement ([Fig. 1]). He was discharged once he was able to consume food by mouth. He was admitted to
the emergency ward 17 days after the procedure with abdominal distension and vomiting.
Fig. 1 A covered self-expandable metal stent was successfully placed for duodenal obstruction
caused by pancreatic cancer.
Computed tomography showed that the stent had migrated into the jejunum, causing an
intestinal obstruction without perforation ([Fig. 2]). As the position of the migrated stent did not change on follow-up X-rays, we decided
to remove the stent using enteroscopy. However, the enteroscope would not pass because
of duodenal stenosis, so we decided to place a second duodenal SEMS ([Fig. 3]). The second SEMS was fully expanded 2 days later, and we successfully passed the
stenosis and reached the first, migrated C-SEMS. To prevent gastrointestinal injury
during stent removal, we attached an overtube to the enteroscope and gently placed
it through the stenosis. Using grasping forceps and a snare, we captured the migrated
C-SEMS within the overtube and safely removed it per orally ([Fig. 4]). No necrosis or perforation was observed where the migrated C-SEMS had been stuck.
After SEMS removal, the patients’ symptoms resolved.
Fig. 2 The stent migrated into the jejunum (yellow triangle), and we confirmed intestinal
obstruction (white triangle) without perforation.
Fig. 3 The enteroscope could not pass the malignant duodenal stenosis; therefore, we placed
a second duodenal self-expandable metal stent. Even with balloon dilation, we were
unable to pass through the duodenal stenosis.
Fig. 4 The second self-expandable metal stent (SEMS) was fully expanded 2 days after duodenal
placement, and we were able to pass through the duodenal stenosis. We were then able
to reach the first migrated covered SEMS that had lodged in the jejunum. Next, we
placed the overtube through the duodenal stenosis (yellow triangle) and straightened
the proximal enteroscope. Using grasping forceps and a snare, we successfully captured
the migrated covered SEMS within the overtube and safely removed it per orally.
This technique might be a useful option for removing a migrated SEMS per orally without
surgery.
Endoscopy_UCTN_Code_CPL_1AH_2AD
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.
This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos
