LAUSR

The European Society of Gastrointestinal Endoscopy recommends temporary esophageal stenting for the treatment of benign esophageal leaks, but there is no consensus on the duration of stent placement [1]. Prolonged stenting can result in tissue hyperplasia that makes removal difficult, and forcible removal can cause esophageal perforation requiring surgery [2]. There are reports that a stent-in-stent approach enables stent removal [3], but it involves the cost of another stent. Argon plasma coagulation (APC) and an endoscopic submucosal dissection (ESD) knife are used to resect hyperplasia and reportedly allow stent removal [4, 5]. We unsuccessfully attempted to cut a stent using APC and completed the procedure by switching to an ESD knife. There are no reports of cutting gastrointestinal stents with an ESD knife and we report the procedure herein (▶Video 1). A covered esophageal stent (Niti-S Esophageal ComVi Stent 18×100mm; TaeWoong Medical, Gimpo-si, South Korea) was implanted in a 76-year-old woman for leakage at the esophageal jejunal anastomosis after proximal gastrectomy (▶Fig. 1, ▶Fig. 2). The leak improved after 4 months and stent removal was attempted, but the proximal and distal flared ends were embedded in the hyperplastic esophageal wall and could not be removed. We used a GIF-Q260 J (Olympus, Tokyo, Japan) scope with tip attachment and a VIO-300D (Erbe Elektromedizin GmbH, Tübingen, Germany). APC was set at Forced APC flow rate of 2 L/min, 100W. Effective stent cutting on the distal side was not possible because the working space was too narrow for selective discharge by APC. Therefore, we changed to a Dual Knife J (Olympus), setting it to Swift coagulation mode effect 4, 40W. While cutting with the ESD knife, it was important to keep a small distance between the tip of the knife and the stent, and to be aware that the knife was cutting with a discharge. Using the ESD knife, the metal parts could be cut selectively and the cover parts easily. The stent was removed by cutting circumferentially.