Aims Endoscopic biliary stenting is a well-established treatment modality for biliopancreatic
diseases. However, stent migration is reported in up to 5%-10%. Extraction of proximally
migrated stents using standard fluoroscopy-guided techniques (guidewire cannulation,baloon,forceps,
Soehendra stent retriever) can be technically challenging, time- consuming and not
always successful. Single-operator cholangioscopy /SOC/ with retrieval under direct
visualization could be a useful tool in such difficult cases. On the other hand, factors
associated with increased risk of stent migration have not yet been well examined.Aims-To evaluate the application of SOC in the management of proximally migrated stents
in terms of efficacy and safety and to analyze factors associated with increased risk
of proximal migration.
Methods We performed a retrospective analysis of a group of 113 consecutive cases of proximally
migrated stents.
Results Patients were divided into two groups.In the first group n=71,different types of
standard retrieval techniques were performed with technical success rate, defined
as successful stent extraction in 70,42% of cases /n=50/.In 21 of the cases after
“conventional” attempt removal was not successful and placement of new plastic stent
was performed.In the second group(n=42), SOC was used as an extraction modality with
technical success rate of 100%.We included also five cases with migrated pancreatic
stents where pancreatoscopy was performed after failure of conventional retrieval
techniques. There was a statistically significant difference in terms of technical
success in favor of the group with cholangioscopy. In the first group adverse events
occured in 12 patients against 6 cases for the second with no significant difference
(p<0.713).The mean procedure time was shorter for the first group with a statistically
significant difference p=0.026.However,it is important to note that in some cases
cholangioscopy was performed after the failure of standard fluoroscopy -guided techniques.
Furthermore, we evaluated the most common risk factors for proximal stent migration
in our group. Placing 10 Fr straight plastic stents, which are less than 10 cm long
were associated with increased risk of proximal migration. As patient related risk
factors we recognized the presence of benign biliary stricture (88.5%), diameter of
the common bile duct more than 10 mm (74.34%) and presence of residual bile duct stones
(35.4%).
Conclusions Cholagioscopy is a technique for the extraction of migrated biliary stents with a
high rate of efficacy and an acceptable rate of adverse events. It could be proposed
as a first choice in cases where failure of standard techniques is suspected/persistent
benign stenosis, residual bile duct stones,extremely dilated common bile duct/ thus
saving time and X -ray exposure in cumbersome cases.
