Retrieval of a migrated biliary stent using a customized goose-neck snare

Stents are commonly used to treat acute cholangitis (AC) and obstructive jaundice caused by strictures of the bile duct (BD) and pancreatic duct. Although rare, stent migration can occur. Stent retrieval is often attempted using forceps, baskets, or balloon catheters; however, the efficacy and reliability of these methods are limited, rendering the retrieval challenging. Several alternative techniques have been reported, including cases where metal and plastic stents (PS) were involved [1] [2] [3] [4].

A woman in her 80s presented with abdominal pain and was diagnosed with AC. Endoscopic retrograde cholangiopancreatography (ERCP) was planned. She had a history of cholangitis several years earlier, during which stone extraction was difficult due to multiple large common bile duct stones, and a PS was placed ([Fig. 1]). In the initial ERCP, removal with grasping forceps failed due to firm adhesion to stones, resulting in stent fracture. Another PS was inserted for drainage, and a second ERCP was planned.

Fig. 1 Multiple large common bile duct (BD) stones surrounding a plastic stent were observed.

After removing the second PS, the initial one was found to have completely migrated. Given its firm adhesion, strong traction was necessary for retrieval.

As the proximal BD was filled with multiple large stones, it was necessary for the stent to be grasped in the BD’s open space using a customized gooseneck-shaped snare. To maintain reliable bending and axial control, the tip of a rotatable snare was fixed to the sheath using nylon thread ([Fig. 2]). The snare was inserted over a guidewire and deployed, allowing strong traction with easy grasping and successful PS removal ([Fig. 3], [Fig. 4], [Video 1]).

Fig. 2 The snare’s tip was tied to the sheath with a nylon thread. Its rotatable design allows for easy adjustment of direction.

Fig. 3 A customized goose-neck snare was able to reproducibly bend within the BD and maintain its shape, allowing secure grasping of the stent’s anal side.

Fig. 4 The migrated stent was securely grasped and successfully removed using the customized goose-neck snare.

Successful retrieval of a fully migrated and adherent biliary stent using a customized goose-neck snare with fixed-angle bending. Strong traction and precise control were achieved without specialized devices.Video 1

Manually bent snares have been reported; however, the curved shape often reverts upon sheath retraction [5]. Our method offers consistent bending and precise axial control. Snare size can be selected based on duct diameter, and no special equipment is required, making this a simple, reproducible approach.

Endoscopy_UCTN_Code_TTT_1AR_2AH

Publication History

Article published online:
11 September 2025

• References

• 1 Ohno A, Fujimori N, Hirahata K. et al. The novel basket catheter for retrieval of a migrated biliary insidestent. Endoscopy 2022; 54: E596-E597
• 2 Al Lehibi A, Al Mtawa A, Almasoudi T. et al. Removal of proximally migrated biliary stents by using. Video GIE 2015; 5: 213-216
• 3 Sumi K, Ushio J, Kato H. et al. Safe and reliable removal of a migrated biliary metal stent with a snare placed over the balloon using the two-devices-in-one-channel method. Endoscopy 2025; (Suppl. 01) E222-E223
• 4 Sumi K, Terai NP, Kato H. et al. The technique for retrieving a fully migrated pancreatic duct stent using a snare placed over the proximal end of biopsy forceps. Endoscopy 2025; (Suppl. 01) E319-E320
• 5 Koga T, Ishida Y, Ishikawa H. et al. Endoscopic transpapillary repositioning of a migrated cystic duct tube using a gooseneck snare technique. Endoscopy 2023; (Suppl. 01) E397-E399