Successful balloon fixation technique to prevent dislocation of a fully covered self-expanding metal stent for biliary stricture

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

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Bartel MJ, Higa JT, Tokar JL. The status of SEMS versus plastic stents for benign biliary strictures. Curr Gastroenterol Rep 2019; 21: 29
• 2 Johanson JF, Schmalz MJ, Geenen JE. Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 1992; 38: 341-346
• 3 Cheruvu S, Kennedy R, Moshenyat Y. et al. Biliary stent migration: a brief review of potential complications and possible etiological factors. Am J Ther 2014; 21: e124-129
• 4 Gromski MA, Bick BL, Vega D. et al. A rare complication of ERCP: duodenal perforation due to biliary stent migration. Endosc Int Open 2020; 8: e1530-1536
• 5 Emara MH, Ahmed MH, Mohammed AS. et al. Biliary stent migration: why, how, and what?. Eur J Gastroenterol Hepatol 2021; 33: 967-973

Publication History

Article published online:
31 January 2025