This 6-minute video describes a reliable technique to remove migrated esophageal stents. Migration of plastic stents used for benign disease is a frequent problem Most of the time they are easy to remove but difficult situations with prolonged procedure times and repeated failures to capture and remove stents do occur. Repeated unsuccessful removal attempts and the use of more force exert stress on weakened sections of the anatomy, for example when removing stents after anastomotic leaks and perforations. In our method the common problem of stent slippage during removal attempts is avoided by piercing an FNA needle through the front and back of a migrated plastic stent close to its end. Subsequently a guidewire is advanced through the FNA needle and received with a polypectomy snare, which is coming through the other working channel of a therapeutic gastroscope. Once both ends of the guidewire are outside the endoscope effective control of the withdrawal force is possible. This force can be so considerable that an overtube is being used to reconstrain or capture the stent rather than allowing it to be pulled expanded through potentially weakened and non-compliant tissue, such as a healed anastomotic leak.
Klaus Gottlieb, MD, University of Washington