{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T18:58:58Z","timestamp":1757617138793,"version":"3.44.0"},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"CP","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>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.<\/jats:p><jats:p>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.<\/jats:p><jats:p>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\u2013392), failure was observed in 15 cases (30%). Previous biliary stenting and dwell stenting period &gt; 300 days were identified as risk factors for FC-SEMS removal failure.<\/jats:p><jats:p>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.<\/jats:p>","DOI":"10.1055\/a-2669-5801","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T22:43:46Z","timestamp":1753742626000},"source":"Crossref","is-referenced-by-count":0,"special_numbering":"S","title":["Fully-covered metal stent removal failure in case of non-malignant biliary strictures: Risk factors and resolution technique"],"prefix":"10.1055","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-681X","authenticated-orcid":false,"given":"Nicol\u00f2","family":"de Pretis","sequence":"additional","affiliation":[{"name":"Medicine, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Santaera","sequence":"additional","affiliation":[{"name":"Medicine, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Martinelli","sequence":"additional","affiliation":[{"name":"Diagnostics and Public Health, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Cristina","family":"Conti Bellocchi","sequence":"additional","affiliation":[{"name":"The Pancreas Institute, Unit of Gastroenterology and Digestive Endoscopy, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Bernardoni","sequence":"additional","affiliation":[{"name":"Medicine, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viola","family":"Fino","sequence":"additional","affiliation":[{"name":"Medicine, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian Miguel","family":"Pezua 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