A DISTALLY MIGRATED BILIARY STENT RECOVERED WITH OVER-THE-WIRE-ASSISTED GRASPING TRIPOD

A 51-year-old man who was undertaken an orthotopic liver transplantation because of an end-stage liver alcoholic disease. In order to prevent a biliary anastomosis stenosis or leakage in the post-transplatation period was positioned at that point a temporary biliary plastic stent. After four months since the trasplantation, the patient, who had remained asymptomatic, was refered to our unit for an scheduled endoscopic removal. An endoscopic retrograde cholangiopancreatography (ERCP) was performed, procedure in which it was noticed that the biliary stent was distally migrated. Moreover, in the cholangiography we could verify that there was an anastomotic biliary stenosis proximally to the stent.

The initial attempt with a sphincterotomy and several passes with a Fogarty balloon (features) not only was failed; contrarily, the stent still moved further away. It was also considered the extraction with a snare or a basket. A rat-tooth forceps or a tripod were another options but blind grasping with any of these devices implied a high risk of complications.

With the goal of remove the stent using a fluoroscopic view, it was introduced a 0.018 wire (features) inside the sheath of a grasping tripod to reach the stent in a not blind procedure. We introduced the over-the-wire-assisted grasped tripod through the papilla and finally stent withdrawal was successfully achieved without any complications. Because there was a biliary stenosis post-transplantation a new plastic stent (features) was placed at that point.

Removal of distally migrated stent that did not appear through the papilla is technically challenging. It is possible to reach further away our endoscopic eyesight with fluoroscopy and different devices we usually have in our endoscopic units. In our case we used a new wire-assisted grasping tripod technique.