Redeployment of proximally misplaced self-expandable metallic stent in an inoperable esophageal carcinoma, using an overtube technique.

Placement of self-expandable metallic stents (SEMSs) has been demonstrated to be a safe palliative procedure for patients with inoperable esophageal cancer and dysphagia [1,2]. When deployed distally from the stricture, most SEMSs can be repositioned endoscopically by pulling the lasso attached to the proximal end of the SEMS. However, if the deployment of the SEMS is completely proximal from the stricture, endoscopic repositioning of the SEMS is challenging. We report here a novel method for redeploying a proximally misplaced SEMS using an overtube. A 70-year-old man attended our institution because of progressive dysphagia andweight loss. Upper endoscopy showed an esophageal tumor near the esophagogastric junction. Abdominal ultrasonography showed multiple liver tumors. Histopathological investigation confirmed the diagnosis of esophageal carcinoma with liver metastasis. A SEMS (Evolution, 12 cm; Cook Endoscopy, Winston-Salem, North Carolina, USA) was placed for the palliative treatment of dysphagia. However, the SEMS was misplaced in a position proximal to the esophageal carcinoma (●" Fig.1). Because the SEMS could not be repositioned distally after full deployment, a self-made transparent overtube with an internal diameter of 6mm was used to retract the SEMS. A guidewire (Jagwire; Boston Fig.1 Endoscopic view of a self-expanding metal stent (SEMS) that had been misplaced proximally from an esophageal tumor. Fig.2 Demonstration of the technique for retracting the self-expanding metal stent (SEMS): a guidewire has been looped through the lasso (see text), and will be used to pull the stent into the self-made transparent overtube as the overtube is pushed in the opposite direction. A blue radiopaque marker is attached at the distal end of the overtube.