Removal of Duckbill‐type laser‐cut anti‐reflux metal stents: Clinical evaluation and in vitro study
Abstract Objectives Duckbill‐type metal stent (DMS) was the first laser‐cut biliary metal stent with an anti‐reflux valve. Removal of DMS is believed to be difficult and relevant reports are scarce. This study aims to investigate the feasibility of DMS removal. Methods We retrospectively analyzed pa...
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Wiley
2023-04-01
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| Online Access: | https://doi.org/10.1002/deo2.217 |
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| author | Yuto Yamada Takashi Sasaki Tsuyoshi Takeda Takeshi Okamoto Takafumi Mie Chinatsu Yonekura Takaaki Furukawa Akiyoshi Kasuga Masato Matsuyama Masato Ozaka Takahisa Matsuda Yoshinori Igarashi Naoki Sasahira |
| author_facet | Yuto Yamada Takashi Sasaki Tsuyoshi Takeda Takeshi Okamoto Takafumi Mie Chinatsu Yonekura Takaaki Furukawa Akiyoshi Kasuga Masato Matsuyama Masato Ozaka Takahisa Matsuda Yoshinori Igarashi Naoki Sasahira |
| author_sort | Yuto Yamada |
| collection | DOAJ |
| description | Abstract Objectives Duckbill‐type metal stent (DMS) was the first laser‐cut biliary metal stent with an anti‐reflux valve. Removal of DMS is believed to be difficult and relevant reports are scarce. This study aims to investigate the feasibility of DMS removal. Methods We retrospectively analyzed patients who underwent DMS removal between June 2019 and March 2022 to evaluate success rates and factors affecting outcomes. In addition, six different methods of DMS removal were reproduced in vitro, varying removal devices, angle of applied force, and grasped location. Extraction resistance, the distance of forceps stroke, and stent length after removal were compared. Results Forty patients were enrolled, and DMS removal was successful in 31 cases (78%). No adverse events were observed. Tumor ingrowth was evident in 78% (7/9) of failed cases. Patients receiving biliary metal stents for the first time (naïve cases), long indwelling time, longer stent, and stent tearing during removal were associated with unsuccessful stent removal. In the in vitro study, a larger force was required to remove the stent at an extraction angle of 120° than at 0°. Among cases in which force was applied at 120°, the load tended to be lower when rat‐tooth forceps were applied horizontally across the stent. Conclusions Stent removal was possible in a majority of cases. Deployment of additional stents inside DMS may be preferable to forceful removal in the presence of factors associated with difficult stent removals, such as tumor ingrowth, naïve cases, longer stents, long indwelling time, and stent tearing during removal. |
| format | Article |
| id | doaj-art-4eeefa2e01a347378bab89ff83227dbd |
| institution | DOAJ |
| issn | 2692-4609 |
| language | English |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | DEN Open |
| spelling | doaj-art-4eeefa2e01a347378bab89ff83227dbd2025-08-20T03:10:01ZengWileyDEN Open2692-46092023-04-0131n/an/a10.1002/deo2.217Removal of Duckbill‐type laser‐cut anti‐reflux metal stents: Clinical evaluation and in vitro studyYuto Yamada0Takashi Sasaki1Tsuyoshi Takeda2Takeshi Okamoto3Takafumi Mie4Chinatsu Yonekura5Takaaki Furukawa6Akiyoshi Kasuga7Masato Matsuyama8Masato Ozaka9Takahisa Matsuda10Yoshinori Igarashi11Naoki Sasahira12Department of Hepato‐Biliary‐Pancreatic Medicine, Cancer Institute Hospital Japanese Foundation for Cancer Research Tokyo JapanDepartment of Hepato‐Biliary‐Pancreatic Medicine, Cancer Institute Hospital Japanese Foundation for Cancer Research Tokyo JapanDepartment of Hepato‐Biliary‐Pancreatic Medicine, Cancer Institute Hospital Japanese Foundation for Cancer Research Tokyo JapanDepartment of Hepato‐Biliary‐Pancreatic Medicine, Cancer Institute Hospital Japanese Foundation for Cancer Research Tokyo JapanDepartment of Hepato‐Biliary‐Pancreatic Medicine, Cancer Institute Hospital Japanese Foundation for Cancer Research Tokyo JapanDepartment of Hepato‐Biliary‐Pancreatic Medicine, Cancer Institute Hospital Japanese Foundation for Cancer Research Tokyo JapanDepartment of Hepato‐Biliary‐Pancreatic Medicine, Cancer Institute Hospital Japanese Foundation for Cancer Research Tokyo JapanDepartment of Hepato‐Biliary‐Pancreatic Medicine, Cancer Institute Hospital Japanese Foundation for Cancer Research Tokyo JapanDepartment of Hepato‐Biliary‐Pancreatic Medicine, Cancer Institute Hospital Japanese Foundation for Cancer Research Tokyo JapanDepartment of Hepato‐Biliary‐Pancreatic Medicine, Cancer Institute Hospital Japanese Foundation for Cancer Research Tokyo JapanDepartment of Internal Medicine Division of Gastroenterology and Hepatology Toho University, Omori Medical Center Tokyo JapanDepartment of Internal Medicine Division of Gastroenterology and Hepatology Toho University, Omori Medical Center Tokyo JapanDepartment of Hepato‐Biliary‐Pancreatic Medicine, Cancer Institute Hospital Japanese Foundation for Cancer Research Tokyo JapanAbstract Objectives Duckbill‐type metal stent (DMS) was the first laser‐cut biliary metal stent with an anti‐reflux valve. Removal of DMS is believed to be difficult and relevant reports are scarce. This study aims to investigate the feasibility of DMS removal. Methods We retrospectively analyzed patients who underwent DMS removal between June 2019 and March 2022 to evaluate success rates and factors affecting outcomes. In addition, six different methods of DMS removal were reproduced in vitro, varying removal devices, angle of applied force, and grasped location. Extraction resistance, the distance of forceps stroke, and stent length after removal were compared. Results Forty patients were enrolled, and DMS removal was successful in 31 cases (78%). No adverse events were observed. Tumor ingrowth was evident in 78% (7/9) of failed cases. Patients receiving biliary metal stents for the first time (naïve cases), long indwelling time, longer stent, and stent tearing during removal were associated with unsuccessful stent removal. In the in vitro study, a larger force was required to remove the stent at an extraction angle of 120° than at 0°. Among cases in which force was applied at 120°, the load tended to be lower when rat‐tooth forceps were applied horizontally across the stent. Conclusions Stent removal was possible in a majority of cases. Deployment of additional stents inside DMS may be preferable to forceful removal in the presence of factors associated with difficult stent removals, such as tumor ingrowth, naïve cases, longer stents, long indwelling time, and stent tearing during removal.https://doi.org/10.1002/deo2.217anti‐reflux metal stentbiliarylaser‐cutself‐expandable metal stentstent removal |
| spellingShingle | Yuto Yamada Takashi Sasaki Tsuyoshi Takeda Takeshi Okamoto Takafumi Mie Chinatsu Yonekura Takaaki Furukawa Akiyoshi Kasuga Masato Matsuyama Masato Ozaka Takahisa Matsuda Yoshinori Igarashi Naoki Sasahira Removal of Duckbill‐type laser‐cut anti‐reflux metal stents: Clinical evaluation and in vitro study DEN Open anti‐reflux metal stent biliary laser‐cut self‐expandable metal stent stent removal |
| title | Removal of Duckbill‐type laser‐cut anti‐reflux metal stents: Clinical evaluation and in vitro study |
| title_full | Removal of Duckbill‐type laser‐cut anti‐reflux metal stents: Clinical evaluation and in vitro study |
| title_fullStr | Removal of Duckbill‐type laser‐cut anti‐reflux metal stents: Clinical evaluation and in vitro study |
| title_full_unstemmed | Removal of Duckbill‐type laser‐cut anti‐reflux metal stents: Clinical evaluation and in vitro study |
| title_short | Removal of Duckbill‐type laser‐cut anti‐reflux metal stents: Clinical evaluation and in vitro study |
| title_sort | removal of duckbill type laser cut anti reflux metal stents clinical evaluation and in vitro study |
| topic | anti‐reflux metal stent biliary laser‐cut self‐expandable metal stent stent removal |
| url | https://doi.org/10.1002/deo2.217 |
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