Endoscopy 2021; 53(06): E209-E210
DOI: 10.1055/a-1244-9219
E-Videos

Endoscopic removal of two duodenal stents that had migrated into the colon, using the invagination method

Takashi Sasaki
1  Department of Hepato-biliary Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Tsuyoshi Takeda
1  Department of Hepato-biliary Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Chihiro Yasue
2  Department of Lower Gastrointestinal Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Junki Tokura
2  Department of Lower Gastrointestinal Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Daisuke Ide
2  Department of Lower Gastrointestinal Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Shoichi Saito
2  Department of Lower Gastrointestinal Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Naoki Sasahira
1  Department of Hepato-biliary Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
› Author Affiliations
 

A 77-year-old woman with advanced pancreatic cancer presented with combined biliary and duodenal malignant obstruction. An uncovered self-expandable metal stent (SEMS) (Nexent Duodenal/Pyloric stent, 22 mm × 12 cm; Next Biomedical, Korea) and a partially covered SEMS (Niti-S ComVi stent, 20 mm × 12 cm; Century Medical, Korea) were deployed for the duodenal obstruction ([Fig. 1]). After three cycles of chemotherapy, the two duodenal SEMSs had migrated to the transverse colon ([Fig. 2]). We decided to remove the SEMSs to avoid perforation. A short-type single-balloon enteroscope (SIF-H290S; Olympus Medical, Japan) was inserted with the overtube ([Video 1]). The SEMSs were identified at the bending part of the colon. We first tried to grasp the distal end with a rat-tooth forceps, but the SEMSs were tightly embedded in the wall. Therefore, the enteroscope was inserted across the SEMSs and the proximal end of the partially covered SEMS was grasped by the forceps and removed using the invagination method. The SEMSs and the enteroscope were pulled into the overtube so as not to injure the intestinal wall. Both SEMSs were successfully removed without any complications ([Fig. 3, ] [Fig. 4, ] [Fig. 5]; [Video 1]).

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Fig. 1 Stent placement to treat malignant duodenal obstruction. A partially covered duodenal stent was deployed as a second stent due to tumor ingrowth into an uncovered duodenal stent.
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Fig. 2 Computed tomography revealed that the two duodenal stents had migrated into the colon.

Video 1 Endoscopic removal of two duodenal stents that had migrated into the colon, using the invagination method.


Quality:
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Fig. 3 Colonoscopic view just after stent removal.
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Fig. 4 Endoscopic view of duodenum where the duodenal stents were previously placed.
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Fig. 5 Colonoscopic view 1 week after stent removal.

Several methods have been reported for removal of migrated enteral SEMSs [1] [2] [3] [4]. Most of these techniques are quite difficult when the distal end is located at the bending part of the colon. The invagination method has been reported to facilitate removal of an embedded biliary SEMS [5]. With this method, the proximal end of the SEMS is grasped with forceps and the SEMS removed by pulling it inside itself. This method could be useful when it is difficult to remove a SEMS from the distal end. It is important to lessen the risk of perforation by advancing the overtube near the SEMS, pulling the enteroscope and the SEMS into the overtube, and gradually, little by little, detaching the SEMS from the intestinal wall.

Endoscopy_UCTN_Code_CPL_1AI_2AD

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Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Takashi Sasaki, MD, PhD
Department of Hepato-biliary Pancreatic Medicine
Cancer Institute Hospital of Japanese Foundation for Cancer Research
3-8-31, Ariake
Koto
Tokyo 135-8550
Japan   
Fax: +81-3-3520-0141   

Publication History

Publication Date:
11 September 2020 (online)

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany


Zoom Image
Fig. 1 Stent placement to treat malignant duodenal obstruction. A partially covered duodenal stent was deployed as a second stent due to tumor ingrowth into an uncovered duodenal stent.
Zoom Image
Fig. 2 Computed tomography revealed that the two duodenal stents had migrated into the colon.
Zoom Image
Fig. 3 Colonoscopic view just after stent removal.
Zoom Image
Fig. 4 Endoscopic view of duodenum where the duodenal stents were previously placed.
Zoom Image
Fig. 5 Colonoscopic view 1 week after stent removal.