A 28-year-old man presented for stent removal one year after endoscopic retrograde
cholangiogram and biliary stenting for anastomotic stricture after living-donor liver
transplantation. On duodenoscopy, two biliary stents were visible at the papilla,
and retrieval was attempted with the aid of a snare. However, only one stent could
be removed completely and the second biliary stent broke off and migrated proximally.
Subsequently, a guidewire was passed parallel to the migrated stent. Then a stone
extraction balloon was passed over the guidewire in an attempt to retrieve the migrated
stent by applying traction via the over-inflated balloon ([Fig. 1]). We could see the broken stent across the papilla upon traction. However, we could
not exchange the balloon in the duodenoscope because the stent repeatedly migrated
inwards once we deflated the balloon and attempted to exchange it for a snare.
Fig. 1 Fluoroscopy image during an endoscopic retrograde cholangiography showing broken,
proximally migrated plastic stent (yellow arrow), along with inflated stone extraction
balloon (blue arrow).
In this scenario, we considered a double-channel therapeutic scope (GIF-2TH180 EVIS
EXERA II gastrovideoscope; Olympus, Tokyo, Japan) to retrieve the stent while simultaneously
applying traction. To support insertion of the therapeutic scope, we initially placed
a 5-Fr guide catheter (Boston Scientific, Marlborough, Massachusetts, USA) over the
guidewire and the duodenoscope was exchanged for the therapeutic scope over the guide
catheter. Once the therapeutic scope reached the papilla, the guide catheter was exchanged
for a stone extraction balloon through one channel of the therapeutic scope and a
snare loaded into the second channel. Then, by applying traction with the inflated
balloon, the stent came across the papilla and the lower end of the stent was caught
with the snare and successfully retrieved ([Video 1], [Fig. 2]).
Video 1 Successful removal of a broken, proximally migrated plastic stent using a double-channel
therapeutic endoscope along with a stone extraction balloon and snare in a patient
with post-transplant biliary stricture.
Fig. 2 Fluoroscopy image showing the snare holding the broken stent with a stone extraction
balloon applying traction (blue arrow) aided by a double-channel therapeutic endoscope
(yellow arrow).
Various techniques have been described for retrieval of a migrated stent using forceps,
a basket, snare, Soehendra stent retriever, cholangioscope, and balloon [1]
[2]
[3]
[4]. To the best of our knowledge, this is the first case that highlights the use of
a therapeutic scope in stent retrieval.
Endoscopy_UCTN_Code_CPL_1AK_2AD
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