TRANSECTION OF METAL STENTS USING ARGON PLASMA COAGULATION

Fracture of self-expandable metallic stent inserted for unresectable gastric cancer at the esophagogastric junction: successful retrieval of distal fragment by gastrotomy

Endoscopic stenting is useful for amelioration of gastrointestinal stenosis. This procedure benefits severely compromised patients who cannot afford surgery. Although the self-expandable metallic stent (SEMS) is safe, it is also associated with several complications such as perforation, migration, and fracture. Migration of a SEMS is not particularly rare; however, fracture of a SEMS is relatively rare. An 88-year-old man underwent stenting for dysphagia at another hospital. He was being treated for gastric cancer at the esophagogastric junction. After appropriate stenting, he regained his ability to eat and was discharged the hospital. Only 2 months later, however, he again lost his ability to eat and visited our hospital. Abdominal X-ray and computed tomography revealed a stent fracture. The proximal fragment was in the esophagus, and the distal fragment was in the stomach. An emergency operation involving gastrotomy and gastrostomy was performed. Open gastrotomy was performed to remove the fractured distal stent, and percutaneous tube gastrostomy was placed through the same gastric incision for nutrition support. The surgery was successful, and he was again able to eat. In this report, we discuss the occurrence of SEMS fracture within a short time periods after insertion.