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Removal of Retrievable Esophageal and Gastrointestinal Stents: Experience in 113 Patients

¹ All authors: Department of Radiology, Asan Medical Center, 388-1, Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea.

View larger version (27K): [in a new window]   Fig. 1. —Diagram depicts Song stent. Drawstrings are attached to margin of stent. Nylon loop (arrows) is hooked inside each bend in proximal end of stent. Two more nylon threads (arrowhead) are passed through each of nylon loops to form two larger loops (drawstrings). This stent design has been described previously [11].

View larger version (99K): [in a new window]   Fig. 2. —Photograph shows hookwire (top) and stent retrieval set (bottom).

View larger version (108K): [in a new window]   Fig. 3A. —74-year-old woman who underwent Song stent placement 6 months after ingesting corrosive agent. Stent was electively removed 8 weeks after placement. Esophagogram obtained before stent placement shows long segmental stricture (arrows) in distal esophagus. Note markedly dilated mid esophagus (arrowhead).

View larger version (79K): [in a new window]   Fig. 3B. —74-year-old woman who underwent Song stent placement 6 months after ingesting corrosive agent. Stent was electively removed 8 weeks after placement. Esophagogram obtained before stent removal shows patent stent and granulation tissue (arrows) above stent.

View larger version (79K): [in a new window]   Fig. 3C. —74-year-old woman who underwent Song stent placement 6 months after ingesting corrosive agent. Stent was electively removed 8 weeks after placement. Radiograph obtained during stent removal shows placement of sheath (arrow) with hookwire (arrowheads) over guidewire into stent lumen.

View larger version (77K): [in a new window]   Fig. 3D. —74-year-old woman who underwent Song stent placement 6 months after ingesting corrosive agent. Stent was electively removed 8 weeks after placement. Radiograph shows hookwire that snagged drawstring of stent and was pulled out to collapse head of stent (arrows). Note hookwire (arrowhead) within sheath.

View larger version (69K): [in a new window]   Fig. 3E. —74-year-old woman who underwent Song stent placement 6 months after ingesting corrosive agent. Stent was electively removed 8 weeks after placement. Esophagogram obtained 3 weeks after stent removal shows widely patent esophageal lumen. Note improvement in granulation tissue (arrowheads).

View larger version (112K): [in a new window]   Fig. 4A. —60-year-old man who underwent Song stent placement for malignant esophageal stricture. Stent was removed because it was compressing airway. Radiographs obtained during stent removal show hookwire (arrows, A) grasping proximal mesh of stent. Stent was pulled out of esophagus with stent head expanded (arrows, B).

View larger version (111K): [in a new window]   Fig. 4B. —60-year-old man who underwent Song stent placement for malignant esophageal stricture. Stent was removed because it was compressing airway. Radiographs obtained during stent removal show hookwire (arrows, A) grasping proximal mesh of stent. Stent was pulled out of esophagus with stent head expanded (arrows, B).

View larger version (86K): [in a new window]   Fig. 5A. —4-year-old boy who underwent Song stent placement for anastomotic stricture that developed after repair of esophageal atresia. Radiographs obtained during stent removal show hookwire grasping distal mesh wire of stent (arrow, A). When hookwire was pulled out, stent was invaginated into itself and was removed in its everted state (B).

View larger version (84K): [in a new window]   Fig. 5B. —4-year-old boy who underwent Song stent placement for anastomotic stricture that developed after repair of esophageal atresia. Radiographs obtained during stent removal show hookwire grasping distal mesh wire of stent (arrow, A). When hookwire was pulled out, stent was invaginated into itself and was removed in its everted state (B).

View larger version (99K): [in a new window]   Fig. 6A. —63-year-old man who underwent placement of Song stent (diameter, 16 mm) for malignant esophageal stricture. Radiograph obtained 2 days after stent placement shows that stent (arrows) has completely migrated into gastric fundus. During initial attempt to introduce guidewire through lumen of stent, guidewire formed loop (arrowheads) before entering stent lumen because of unfavorable direction of long axis of stent. Stent removal failed because retrieval set could not be advanced over looped guidewire.

View larger version (144K): [in a new window]   Fig. 6B. —63-year-old man who underwent placement of Song stent (diameter, 16 mm) for malignant esophageal stricture. Radiograph obtained after placing patient in prone position and inflating stomach with air shows that stent has moved into body of stomach (arrowheads) and guidewire could be introduced through stent without forming loop.

View larger version (104K): [in a new window]   Fig. 6C. —63-year-old man who underwent placement of Song stent (diameter, 16 mm) for malignant esophageal stricture. Radiograph obtained while hooked stent was being pulled out of lower esophagus shows collapsed proximal end (arrow) of stent. Mid portion of stent is partially collapsed due to esophageal stricture (arrowhead).

View larger version (103K): [in a new window]   Fig. 7A. —64-year-old man who underwent Song stent placement (diameter, 32 mm; length, 9 cm) for rectal cancer. Stent distally migrated 3 days after placement. Radiograph obtained during stent removal (standard technique) shows placement of sheath (arrow) and hookwire (arrowhead) over guidewire into stent lumen.

View larger version (98K): [in a new window]   Fig. 7B. —64-year-old man who underwent Song stent placement (diameter, 32 mm; length, 9 cm) for rectal cancer. Stent distally migrated 3 days after placement. Radiograph shows collapsed stent head (arrows) being pulled out of rectum. Another stent was placed immediately after removal of migrated stent.

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