Endoscopy 2022; 54(05): E210-E211
DOI: 10.1055/a-1486-6659
E-Videos

Successful biliary stone removal after resolution of post-endoscopic sphincterotomy papillary stenosis using temporary covered metal stent placement

Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
,
Koji Uno
Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
,
Kenjiro Yasuda
Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
› Author Affiliations

Although few studies have reported the frequency of papillary stenosis after endoscopic sphincterotomy (EST), serious complications such as bleeding and duodenal perforation are reported with repeated EST [1]. For benign biliary stenosis, the usefulness of temporary placement of a fully covered self-expandable metal stent (FCSEMS) is reported [2]. Herein, we describe successful biliary stone removal after resolution of post-EST papillary stenosis using temporary placement of a dumbbell-shaped FCSEMS (BONASTENT M-Intraductal; Sci-Tech Inc., Seoul, South Korea), which has a central saddle portion with a diameter 2 mm less than that of the proximal and distal portions to prevent stent migration.

A 79-year-old man who underwent total gastrectomy for gastric cancer 30 years previously was admitted to our hospital because of a recurrent biliary stone. The patient had undergone single-balloon enteroscopy (SBE)-assisted EST with lithotripsy for biliary stones 4 months prior to the present admission. The latest SBE showed a post-EST scar on the papilla ([Fig. 1]); subsequent cholangiography showed an 8-mm biliary stone. Endoscopic papillary balloon dilation was performed using a 10-mm balloon, but the post-EST papilla was hard, stenosed, and could only be dilated to 5 mm ([Fig. 2]). Lithotripsy was attempted but failed because the stone could not be grasped with a mechanical lithotripter. Therefore, an FCSEMS (10 mm × 4 cm) was placed across the papilla for stenosis resolution. Finally, a double-pigtail plastic stent was placed in the FCSEMS to prevent stone impaction ([Fig. 3]). The patient was readmitted 4 weeks later for stone removal. After the FCSEMS was removed, the stenosis was found to have resolved ([Fig. 4]) and the stone was successfully removed using a retrievable balloon catheter ([Video 1]).

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Fig. 1 Endoscopic image showing the post-endoscopic sphincterotomy scar on the papilla.
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Fig. 2 Cholangiogram showing an 8-mm stone in the common bile duct (red arrow). The papilla was hard and stenosed, and could only be dilated to 5 mm (yellow arrow) during endoscopic papillary balloon dilation using a 10-mm balloon.
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Fig. 3 Endoscopic image showing a double-pigtail plastic stent placed through a dumbbell-shaped fully covered self-expandable metal stent that had been placed across the papilla.
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Fig. 4 Endoscopic image 4 weeks later showing resolution of the stenosis after removal of the fully covered self-expandable metal stent.

Video 1 Successful biliary stone removal after resolution of post-endoscopic sphincterotomy papillary stenosis using dumbbell-shaped covered metal stent placement.


Quality:

Our procedure was safe and could be useful for troubleshooting when removal of biliary stones is difficult because of hard stenosis of the papilla after EST.

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Publication History

Publication Date:
12 May 2021 (online)

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