Background: Endoscopic removal of malfunctioning self-expandable metallic biliary stents (SEMS) is difficult and not well described. The aim of this study is to review the indications, the techniques, and the results of SEMS removal in a cohort of patients with malfunctioning stents. Methods: All patients who underw ent an attempt at endoscopic removal of biliary SEMS over a 5-year period were retrospectively identified. The main indications for SEMSremovalwere the followi ng: distal migration of the stent or impaction to the duodenum, impaction into t he bile-duct wall, tissue ingrowth, and inappropriate length of the stent causi ng occlusion of intrahepatic ducts. SEMS were removed by using foreign-body for ceps or polypectomy snares. Results: Endoscopic removal of 39 SEMS (13 uncovered and 26 covered) was attempted in 29 patients (17 men; mean age, 66 years). SEMS extraction was attempted after a mean of 7.5 months (8.75 months standard devia tion) post-SEMS insertion. Removal was successful in 20 patients (68.9%) and i n 29 SEMS (74.3%). Covered SEMS were effectively removed more frequently than u ncovered ones: 24 of 26 (92.3%) and 5 of 13 (38.4%), respectively (p < 0.05). No major complications were recorded. Multivariate analysis showed that the time interval between insertion and removal, SEMS length, stent-mesh design (zigzag vs. interlaced), and indication for removal were no t predictive of success at stent removal. Conclusions: Endoscopic removal of bil iary SEMS is feasible and safe in more than 70%of cases. Because only 38%of un covered SEMS were removable, the presence of a stent covering is the only factor predictive of successful stent extraction. The presence of diffuse and severe i ngrowth was the main feature limiting SEMS removal.
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