Fully-covered-self-expandable-metal-stents (FC-SEMS) are commonly used for non-malignant biliary stricture treatment. Removal failure related to hyperplastic tissue development over the distal margin of the stent has been described but few data are available. FC-SEMS-in-FC-SEMS technique has been described in case reports to overcome FC-SEMS removal failure. Aims of this study were investigating technical success, clinical success, and safety of the FC-SEMS-in-FC-SEMS technique and identification of risk factors for FC-SEMS removal failure in patients with non-malignant distal biliary stricture.

Endoscopic retrograde cholangiopancreatography (ERCP) procedures performed between January 1, 2020 and May 31, 2023 for FC-SEMS removal in non-malignant distal biliary strictures were retrospectively identified and analyzed. Cases of FC-SEMS-in-FC-SEMS technique were evaluated.

FC-SEMS-in-FC-SEMS technique was used in 15 patients. FC-SEMS removal was achieved after a single treatment in 13 patients (86.7%). In the remaining two patients (13.3%), it was necessary to repeat treatment to achieve FC-SEMS removal, with an overall technical and clinical success of 100%. No significant adverse events were recorded. Among the 50 patients undergoing ERCP for FC-SEMS removal during the study period (median dwell stenting period of 306.5 days; Q1-Q3:160–392), failure was observed in 15 cases (30%). Previous biliary stenting and dwell stenting period > 300 days were identified as risk factors for FC-SEMS removal failure.

FC-SMES-in-FC-SEMS technique appears to be safe and effective to overcome FC-SEMS removal failure in patients with non-malignant distal biliary strictures. Reducing dwell stenting period, especially in patients with personal history of previous biliary stenting, may reduce risk of FC-SEMS removal failure.

Received: 28 February 2025

Accepted after revision: 25 June 2025

Accepted Manuscript online:
28 July 2025

Article published online:
05 September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Bibliographical Record
Nicolò de Pretis, Lorenzo Santaera, Luigi Martinelli, Maria Cristina Conti Bellocchi, Laura Bernardoni, Viola Fino, Adrian Miguel Pezua Sanjinez, Enrico Gasparini, Armando Gabbrielli, Luca Frulloni, Stefano Francesco Crinó. Fully-covered metal stent removal failure in case of non-malignant biliary strictures: Risk factors and resolution technique. Endosc Int Open 2025; 13: a26695801.
DOI: 10.1055/a-2669-5801