The endoscopic overtube is a safe device for removing a fistulizing esophageal metal stent: a literature review

INTRODUCTION: Self-expandable metal stents are the gold standard for palliation of malignant dysphagia. Stent-associated esophageal-respiratory fistulas developed in 4% of patients causing a potentially life threatening emergency. When a fistula occurs, stent removal can be very challenging and related to increased risk for further complications. The aim of this paper was to perform a literature review on previous overtube-assisted reports for difficult esophageal stent removal. We also describe a safe method to remove a fully covered self-expandable metal stent prolapsing into the tracheal lumen by using a new type of overtube to reduce the risk of major injury. EVIDENCE ACQUISITION: All relevant articles were extracted up to December 2017 based on the results of searches in PubMed, Scopus and Google Scholar. EVIDENCE SYNTHESIS: A total of 6 case reports and 2 case series were included, for a total of 14 patients. The most frequent indications to stent placement were malignant strictures due to esophageal cancer or cardiac gastric cancer. The complications for which it was necessary to remove the stent were: occlusion, migration, strangulation, tissue overgrowth or ingrowth, embeeding, and epidural abscess and diskitis. In all cases at the time of stent removal no procedure related complications occurred. CONCLUSIONS: Using an overtube during removal of the stent increased patients safety during the procedure, reducing the risk of trauma and protecting the oesophageal wall.