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Prolonged SEMS retention for refractory variceal bleeding allows removal after 387 daysDoctors successfully remove a metal stent after one year of use

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Key Takeaway
Consider SEMS removal feasible after prolonged retention, but not as routine practice.

This is a case report of a 72-year-old woman with decompensated cirrhosis who presented with refractory esophageal variceal bleeding (REVB). She was treated with a fully covered self-expanding metal stent (SEMS) to achieve hemostasis, followed by transjugular intrahepatic portosystemic shunt (TIPS) placement. The report focuses on the technical feasibility of removing the SEMS after prolonged retention.

Immediate hemostasis was achieved following SEMS deployment. The stent was successfully removed after 387 days of retention. Complete resolution of esophageal varices was observed. The patient experienced intermittent acid regurgitation, retrosternal discomfort, mucosal ulceration, granulation tissue, and two episodes of hepatic encephalopathy during the follow-up period.

The authors note significant limitations: this is a single case report, and the observation is not intended to support routine prolonged stent placement. The findings suggest technical feasibility but do not constitute a recommendation for clinical practice.

For clinicians, this case highlights that prolonged SEMS retention may be technically manageable in select circumstances, but it should not be considered standard care. The management of REVB typically involves a multidisciplinary approach, and decisions about stent duration should be individualized.

How this fits prior evidence

This case report extends prior coverage on variceal bleeding management by illustrating a rescue strategy after failure of standard therapies. Prior evidence showed carvedilol and endoscopic variceal ligation offer comparable efficacy for preventing variceal bleeding, and multidisciplinary teams may improve outcomes in acute gastrointestinal bleeding. This case addresses a gap by demonstrating that a fully covered SEMS can be removed after prolonged retention (387 days) in a patient with refractory bleeding, though it does not change the recommendation for routine practice.

Living with cirrhosis can lead to dangerous bleeding in the esophagus. To stop this, doctors sometimes use a metal stent to keep the area open. Usually, these stents are not intended to stay in for long periods, but a recent case involving a 72-year-old woman showed a different path.

In this case, the patient had a fully covered metal stent that stayed in place for 387 days. Despite the long stay, the stent successfully stopped her bleeding and helped her symptoms. When doctors finally removed the stent after more than a year, they found it could be done successfully even after such a long time.

While this result shows it is technically possible to remove a stent after a year, it is not a recommendation for everyday practice. The patient did experience some side effects like acid reflux and discomfort, but the procedure was successful. Because this was only one person, more research is needed before this becomes a standard way to treat patients.

What this means for you:
A metal stent can be successfully removed after a year, though it is not currently recommended as routine practice.

Common questions

Is it safe to leave a metal stent in for a long time?

In this specific case, a patient had a stent for 387 days. While it successfully stopped her bleeding and resolved her varices, the doctors noted that keeping a stent in for a long time is not currently recommended as a routine practice. You should talk to your doctor about the best plan for your specific condition.

What are the risks of having a stent for esophageal varices?

The patient in this report experienced some side effects, including acid regurgitation, discomfort, and mucosal ulceration. She also had two episodes of hepatic encephalopathy. Because this was a single case, these results do not represent all possible outcomes for every patient.

Can a stent be removed after a year of use?

Yes, this case shows that a fully covered metal stent was successfully removed after 387 days. While it shows the procedure is technically possible, the report notes that this specific case is not intended to support routine long-term stent placement as a standard medical practice.

Study Details

Study typeGuideline
EvidenceLevel 5
PublishedSep 2026
View Original Abstract ↓
Background and aimsRefractory esophageal variceal bleeding (REVB) in patients with cirrhosis is associated with high mortality. Self-expanding metal stents (SEMS) serve as a salvage therapeutic option. However, data regarding their prolonged use as a bridge to transjugular intrahepatic portosystemic shunt (TIPS) remain limited. We report a case in which REVB was managed with prolonged SEMS placement before TIPS.Case presentationA 72-year-old female with decompensated cirrhosis presented with acute hematemesis. After failure of endoscopic injection sclerotherapy and band ligation to control active bleeding from a ruptured esophageal varix, a fully covered SEMS was successfully deployed. The patient declined the scheduled stent removal and was subsequently followed conservatively. TIPS was performed 387 days after stent placement, followed by a successful stent retrieval. Clinical outcomes, including rebleeding episodes and procedure-related complications, were recorded throughout follow-up until July 26, 2026.ResultsImmediate hemostasis was achieved following SEMS deployment. During the 387-day indwelling period, the patient developed intermittent acid regurgitation, retrosternal discomfort, and endoscopic evidence of mucosal ulceration and granulation tissue at the stent site. The stent was successfully removed after TIPS, and follow-up endoscopy revealed complete resolution of the esophageal varices. The patient remained free of recurrent bleeding till the last follow-up. However, two episodes of hepatic encephalopathy occurred after TIPS.ConclusionThis case suggests that successful removal of a fully covered esophageal SEMS may remain technically feasible even after an exceptionally prolonged retention period. Nonetheless, this observation should not be interpreted as support for routine prolonged stent placement, which lies outside current guideline recommendations and may entail substantial risks.
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