AN INUSUAL BRIDGEABLE COMPLICATION IN A CHANGED-OVER-TIME METAL STENT

A 57-year-old-woman with obstructive jaundice secondary to chronic pancreatitis. She was underwent an ERCP in which it was diagnosed a benign stenosis of common bile duct as well as pancreatic duct. Endoscopic drainage was undertaken with two stents, a fully-covered metal stent (SEMS) for bile duct and a plastic stent (PPS) for the Wirsung. A 6 months follow-up was planned to remove both stents, but the patient did not appear. After 3-years the patient reappear. PPS was removed without difficulties but it was not feasible to remove SEMS because it had missed its cover and it was working as a bare metal stent impossible to displaced without damaging. Moreover, SEMS had a lot of mud so it must be removed to avoid a subsequent abnormal functioning. In order to make possibe a deferred removal, we performed a placing of a second SEMS inside the previous one. Endoscopically, we tought we had successfully introduced the second SEMS, but when we verified the fluoroscopic placement we realized that the first half of the stent was in the correct position (inside the metal stent previously placed), but the second furthest half which we could not see with the scope was in a parallel position in relation to the first SEMS (it would have left the first stent through a lateral-side hole). We proceeded to pull out the second SEMS from its wrong position without complications. We had a completely new stent and still a patient that carried a stent that was about to dysfunction, so we decided to reintroduce the new SEMS inside an OASIS, after lubricating, and using it again. Firstly, we tried to push the stent with a grasping tripod, but it was not enough stiff, so we changed it for a biopsy forceps whose stiffness allowed us finally push the stent inside the another one in the correct planned position. This case reports a method to reuse a stent with material that we usually have in the endoscopic unit.