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Review
. 2014 Feb 16;6(2):49-54.
doi: 10.4253/wjge.v6.i2.49.

Endoscopic management and prevention of migrated esophageal stents

Bruno da Costa Martins  1 , Felipe Alves Retes  1 , Bruno Frederico Medrado  1 , Marcelo Simas de Lima  1 , Caterina Maria Pia Simione Pennacchi  1 , Fabio Shiguehissa Kawaguti  1 , Adriana Vaz Safatle-Ribeiro  1 , Ricardo Sato Uemura  1 , Fauze Maluf-Filho  1
Affiliations
Review

Endoscopic management and prevention of migrated esophageal stents

Bruno da Costa Martins et al. World J Gastrointest Endosc. .

Abstract

The use of self-expandable metallic stents has increased recently to palliate inoperable esophageal neoplasia and also in the management of benign strictures. Migration is one of the most common complications after stent placement and the endoscopist should be able to recognize and manage this situation. Several techniques for managing migrated stents have been described, as well as new techniques for preventing stent migration. Most stents have a "lasso" at the upper flange which facilitates stent repositioning or removal. An overtube, endoloop and large polypectomy snare may be useful for the retrieval of stents migrated into the stomach. External fixation of the stent with Shim's technique is efficient in preventing stent migration. Suturing the stent to the esophageal wall, new stent designs with larger flanges and double-layered stents are promising techniques to prevent stent migration but they warrant validation in a larger cohort of patients.

Keywords: Benign strictures; Complications; Endoscopy; Esophageal cancer; Stents.

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Figures

Figure 1
Figure 1
Endoscopic removal. A: Rat-toothed grasper inside the biliary stent pusher; B: Stent border constrained by the grasper and pusher together.
Figure 2
Figure 2
The Niti-S stent has a double-layered configuration. The inner covered layer protects against tumor ingrowth and the additional uncovered mesh helps to resist migration.
Figure 3
Figure 3
A length of dental floss or equivalent thread is grasped with a biopsy forceps and passed through the working channel of a standard endoscope. A: The dental floss is grasped with a biopsy forceps; B: The dental floss is passed through the stent mesh from the outside to the inside and carried down using the biopsy forceps; C: The dental floss is inserted into a nasoenteral tube, which is pushed down towards the mesh to protect the nasopharyngeal mucosa.
Figure 4
Figure 4
Endoscopic clips may be applied at the upper border of the stent to prevent migration.
See this image and copyright information in PMC

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