Endoscopic Sub‐Stent Dissection for Removal of Long‐Term Embedded Esophageal Self‐Expanding Metallic Stents

ABSTRACT Background and Aim Self‐expanding metallic stents (SEMS) have been extensively applied to manage esophageal disorders. The hyperplastic mucosal tissue induced by the stent can provide a good anchoring function but also make the stent removal difficult, especially after long‐term placement. Here, we report a new technique, endoscopic sub‐stent dissection, for removing the long‐term embedded SEMS and assessing its safety and efficacy. Methods Patients with long‐term embedded esophageal SEMS who underwent endoscopic sub‐stent dissection between July 2018 and September 2024 were analyzed retrospectively. Demographic characteristics, procedure‐related parameters, adverse events, and long‐term outcomes were investigated. Results A total of 16 patients with 17 embedded esophageal SEMS were included, where three patients had undergone a failed attempt using the stent‐in‐stent technique. Five patients (31.25%) were diagnosed with esophageal fistula, seven (43.75%) with stenosis, one (6.25%) with diverticulum, and three (18.75%) were placed for sealing the defects of endoscopic resection. Nine (52.94%) were partially covered SEMS (PCSEMS) and eight (47.06%) were fully covered SEMS (FCSEMS). The median stent retention time was 88.5 days (range, 28–1080). All embedded stents (100.0%) were successfully removed. The median procedure time was 26 min (range, 10–140). Procedure‐related adverse events included one fever (6.25%) and one subcutaneous emphysema (6.25%). Three patients underwent outpatient surgery, and the median postoperative hospital stay was 3 days (range, 1–49). Conclusions Endoscopic sub‐stent dissection is relatively safe and effective for removing long‐term embedded esophageal SEMS. Further study with a larger sample size is warranted.