Fully covered self-expanding metal stents (FCSEMSs) are commonly used to manage benign
biliary strictures [1]. However, stent migration and dislocation during and after endoscopic retrograde
cholangiopancreatography (ERCP) remain a challenge [2]
[3]
[4]
[5]. Stent dislocation rarely occurs when the delivery system catches on the stent during
removal. This case report demonstrates the successful prevention of stent dislocation
using a balloon catheter inserted through the percutaneous transhepatic biliary drainage
(PTBD) route.
An 83-year-old man who had undergone living-donor liver transplantation was referred
to our hospital to address an anastomotic biliary stricture (ABS) and to extract intrahepatic
stones. Computed tomography revealed intrahepatic bile duct dilatation secondary to
hepatolithiasis ([Fig. 1]
a). Although endoscopic retrograde cholangiography confirmed the presence of intrahepatic
stones, stone removal was not possible because of severe ABS ([Fig. 1]
b). The patient subsequently underwent PTBD, and the stones were successfully removed
from the common bile duct using electrohydraulic lithotripsy via the PTBD route ([Fig. 1]
c).
Fig. 1 Computed tomography and cholangiography images. a Computed tomography showed intrahepatic bile duct dilatation due to hepatolithiasis
(arrow). b Cholangiography showed severe anastomotic biliary stricture (arrowhead) and intrahepatic
stones (arrow). c Electrohydraulic lithotripsy was performed through a percutaneous transhepatic biliary
drainage route.
Subsequently, insertion of an FCSEMS (BonaStent M-intraductal; Standard Sci Tech,
Seoul,
South Korea) was attempted to improve the ABS. During removal of the delivery system,
the stent
dislodged because the catheter tip became caught on the stent ([Fig. 2]
a, b). To prevent stent dislocation, a balloon catheter was
inserted through the PTBD route, positioned at the proximal end of the metal stent,
and
inflated. This technique successfully stabilized the stent, allowing safe removal
of the
delivery system without further stent displacement ([Fig. 2]
c, d, [Video 1]). No adverse events, including stent dislocation, were observed after the procedure
([Fig. 2]
e).
Fig. 2 Cholangiography and schematic diagrams. a, b The delivery
system could not be removed after metal stent deployment (circle). c,
d A balloon catheter was used to stabilize the stent and prevent dislocation during
removal of the delivery system (arrow). e Cholangiography showed
successful metal stent placement.
Balloon fixation technique to prevent dislocation of the metal stent.Video 1
This case demonstrates that using a balloon catheter via the percutaneous route can
effectively prevent stent dislocation during ERCP when the delivery system is caught
on the stent. This straightforward yet effective technique may be useful in preventing
stent dislodgment during challenging biliary interventions.
Endoscopy_UCTN_Code_CPL_1AK_2AZ
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