Metal biliary stent transection with over-the-scope clip removal system.

BACKGROUND AND AIMS: Uncovered self-expandable metal stents (UC-SEMSs) are used for unresectable pancreaticobiliary malignancies. These stents can fray, causing malfunction, ulceration, and perforation. Trimming frayed UC-SEMSs is challenging and risks injury to adjacent structures. Argon plasma coagulation (APC) has shown success transecting and shortening stent wires, but the technique can be cumbersome and time-consuming and risk tissue injury. No standardized power settings exist (65-85 W; 0.5-2 L/min). We present 2 cases of distorted UC-SEMSs requiring transection using a bipolar endoscopic system designed for over-the-scope clip (OTSC) removal. Electrosurgical generator costs are comparable (U.S. $3000-$7000), and single-use catheters cost U.S. $250-$500, making relative costs similar.

METHODS

Two distorted indwelling UC-SEMSs were transected with a bipolar OTSC removal device to accommodate further interventions. Electrical pulses fired only with adequate metal contact. The paired generator required several minutes of charging; alternative generators were incompatible.

RESULTS

In both cases, aberrant UC-SEMSs were successfully restructured using an OTSC removal system without adverse events or tissue injury.

CONCLUSIONS

APC can transect UC-SEMS wires, but these cases show a safe, effective, off-label method using an OTSC removal system.