Abstract: We thank Baptista and colleagues for the interest in our article and appreciate the effort to send us a letter with their comments. The issue that was raised about the stent being in contact with the esophageal wall and getting fixed to the mucosa was not a mandatory criterion for inclusion into our study. We focused on the safety of esophageal stent removal in general, and all temporary stents were therefore included for analysis.The growth of granulation tissue is a well-known complication of esophageal stent placement, and it can complicate stent extraction by embedding the stent into the esophageal wall. A recently introduced strategy for the removal of embedded stents is the stent-in-stent technique.1Hirdes M.M. Siersema P.D. Houben M.H. et al.Stent-in-stent technique for removal of embedded esophageal self-expanding metal stents.Am J Gastroenterol. 2011; 106: 286-293Crossref PubMed Scopus (85) Google Scholar The stent-in-stent procedure has been reported in only a few series in the literature, and specific data on safety are sparse, as for stent removal in general. We therefore thought that this technique should not be excluded. It might be superfluous to mention that the procedure during which both stents were removed has been seen as one stent extraction, so the removal of the inner stent did not favor our results.In as much as another series on esophageal stent removal excluded migrated stents and noted that they “pose a distinct challenge to the endoscopist,”2van Heel N.C. Haringsma J. Wijnhoven B.P. et al.Endoscopic removal of self-expandable metal stents from the esophagus (with video).Gastrointest Endosc. 2011; 74: 44-50Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar it could be considered a significant risk in the application of stent therapy in the esophagus. To verify this statement and to analyze the effect on the outcome of stent removal, we purposely included migrated stents as a separate subgroup in our study. Our results show that stent migration was associated with a successful outcome, which can be explained by the fact that migrated stents are mobile and are not attached to the esophageal wall, as noted by Baptista and colleagues.The experience of Baptista and colleagues that there is a correlation between the radial force of the stent and the outcome of removal is an interesting subject for future research. It can be speculated that the radial force of the stent is related to the growth of granulation tissue.3Siersema P.D. Stenting for benign esophageal strictures.Endoscopy. 2009; 41: 363-373Crossref PubMed Scopus (67) Google Scholar We thank Baptista and colleagues for the interest in our article and appreciate the effort to send us a letter with their comments. The issue that was raised about the stent being in contact with the esophageal wall and getting fixed to the mucosa was not a mandatory criterion for inclusion into our study. We focused on the safety of esophageal stent removal in general, and all temporary stents were therefore included for analysis. The growth of granulation tissue is a well-known complication of esophageal stent placement, and it can complicate stent extraction by embedding the stent into the esophageal wall. A recently introduced strategy for the removal of embedded stents is the stent-in-stent technique.1Hirdes M.M. Siersema P.D. Houben M.H. et al.Stent-in-stent technique for removal of embedded esophageal self-expanding metal stents.Am J Gastroenterol. 2011; 106: 286-293Crossref PubMed Scopus (85) Google Scholar The stent-in-stent procedure has been reported in only a few series in the literature, and specific data on safety are sparse, as for stent removal in general. We therefore thought that this technique should not be excluded. It might be superfluous to mention that the procedure during which both stents were removed has been seen as one stent extraction, so the removal of the inner stent did not favor our results. In as much as another series on esophageal stent removal excluded migrated stents and noted that they “pose a distinct challenge to the endoscopist,”2van Heel N.C. Haringsma J. Wijnhoven B.P. et al.Endoscopic removal of self-expandable metal stents from the esophagus (with video).Gastrointest Endosc. 2011; 74: 44-50Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar it could be considered a significant risk in the application of stent therapy in the esophagus. To verify this statement and to analyze the effect on the outcome of stent removal, we purposely included migrated stents as a separate subgroup in our study. Our results show that stent migration was associated with a successful outcome, which can be explained by the fact that migrated stents are mobile and are not attached to the esophageal wall, as noted by Baptista and colleagues. The experience of Baptista and colleagues that there is a correlation between the radial force of the stent and the outcome of removal is an interesting subject for future research. It can be speculated that the radial force of the stent is related to the growth of granulation tissue.3Siersema P.D. Stenting for benign esophageal strictures.Endoscopy. 2009; 41: 363-373Crossref PubMed Scopus (67) Google Scholar Removing in situ esophageal stentsGastrointestinal EndoscopyVol. 78Issue 1PreviewWe read with interest the article “Safety of endoscopic removal of self-expandable stents after treatment of benign esophageal diseases.”1 We believe there are some considerations that should be made regarding 2 subsets of patients who should have not been included in this study and that possibly explain the unusually extraordinary results reported by the authors. In the first place, patients needing an inner stent for the “stent in stent” retrieving technique should not have been accounted for, because in this technique the inner stent is not in contact with the esophageal wall. Full-Text PDF
Publication Year: 2013
Publication Date: 2013-07-01
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
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