Novel method for retrieving a migrated plastic stent using an 11.5-Fr pusher sheath: The stent encapsulation method

Plastic stent placement using endoscopic retrograde cholangiopancreatography (ERCP) is a widely used biliary drainage technique [1]. Migration of the plastic stent is a major adverse effect. Retrieval grasping techniques using baskets, snares, forceps, and balloon catheters have been reported [2]; however, these techniques are not always successful because of biliary stenosis and tight anchoring of plastic stent flaps [3]. Herein, we introduce a novel method for retrieving a migrated plastic stent using an 11.5-Fr pusher sheath.

A 58-year-old woman with a history of multiple endoscopic treatments, including placement of a metallic stent and a plastic stent inside the metallic stent, for distal biliary obstruction caused by malignant lymphoma, was admitted to our institution because of cholangitis ([Fig. 1]). Computed tomography revealed a dilated intrahepatic bile duct, which was suspected to be related to stent occlusion. We performed endoscopic retrograde cholangiopancreatography (ERCP) and attempted to retrieve the plastic stent using forceps, a snare, and a balloon catheter; however, these attempts failed because of the tight anchoring of a flap of the plastic stent to the metallic stent and the migration of the plastic stent into the bile duct.

Fig. 1 X-ray of 58-year-old woman showing possibly occluded plastic stent coaxial within a metallic stent, placed for distal biliary obstruction caused by malignant lymphoma.

Therefore, we decided to try a stent encapsulation method ([Video 1]). We passed a 0.025-inch guidewire through the plastic stent and advanced an 11.5-Fr pusher sheath (Oasis; Cook Medical, Bloomington, Indiana, USA) over the guidewire. Forceps (E634045; Olympus Medical Systems, Tokyo, Japan) were then inserted through the pusher sheath ([Fig. 2]). The end of the plastic stent was then grasped with the forceps ([Fig. 3]). The 11.5-Fr pusher sheath device was advanced into the bile duct over the forceps encasing the entire length of the plastic stent ([Fig. 4]), including the flap. The plastic stent was then removed successfully through the pusher sheath. Finally, another metallic stent was deployed inside the previously placed metallic stent ([Fig. 5]).

Successful removal of a migrated and tightly stuck biliary plastic stent using a novel stent encapsulation method.Video 1

Fig. 2 Forceps are passed through an 11.5-Fr pusher sheath on the guidewire.

Fig. 3 The forceps are used to grasp the end of the migrated plastic stent.

Fig. 4 The 11.5-Fr pusher sheath is advanced over the forceps to encase the entire length of the migrated stent.

Fig. 5 Another metallic stent is deployed inside the previously placed metallic stent.

This novel method can be useful for removing a migrated plastic stent after advancement of a sheath device beyond a stricture.

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Artikel online veröffentlicht:
07. Februar 2024

• References

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• 2 Tarnasky PR, Cotton PB, Baillie J. et al. Proximal migration of stents: attempted endoscopic retrieval in forty-one patients. Gastrointest Endosc 1995; 42: 513-520
• 3 Calcara C, Broglia L, Comi G. et al. Plastic biliary stent migration during multiple stents placement and successful endoscopic removal using intra-stent balloon inflation technique: a case report and literature review. Am J Case Rep 2016; 17: 65-69