Endoscopic trimming of metallic stents with the use of argon plasma

Background: The endoscopic placement of metallic stents for palliation of malignant obstruction of the GI or biliary tract is an established practice and as such is often applied. Use of these stents, however, has its problems. Stent migration may cause obstruction of the bowel lumen. Migration of a biliary stent into the contralateral duodenal wall may cause difficulty in gaining access to the biliary tract, as will the placement of a duodenal stent across the ampulla. Objective: We report on 6 patients in whom trimming of the metallic nitinol stent was performed. Design: Single-center, retrospective case series. Setting: Secondary referral center. Patients: Of 6 patients included, 2 patients each had an uncovered duodenal stent, 2 had an uncovered biliary stent each, 1 had an uncovered colorectal stent, and I had a covered gastroduodenal stent. Interventions: Under direct endoscopic vision, an argon plasma beam was used to cut self-expandable metallic stents, as appropriate. Main Outcome Measurement: The main objective was relief of the obstruction to the bowel lumen or bile duct, facilitating successful passage of an endoscope or biliary canulation, respectively. Results: In all 5 patients with uncovered metallic stents, we were able to re-establish access to the obstructed bowel lumen or the biliary tree, as indicated. An attempt to tailor the length of a covered metallic gastroduodenal stent failed. No complications were observed and no hemorrhage or perforation occurred. Limitations: The study was limited by retrospective design and small sample size. Conclusions: The endoscopic cutting and tailoring of an uncovered metallic prosthesis, by means of an argon plasma beam, is feasible, effective, and safe. Trimming of covered stents is not advocated.