The use of endoscopic stents is common in the treatment of biliary
tract stenosis. However, the proximal migration of these stents occasionally
results in complications that are difficult to manage [1]. Various techniques for stent retrieval have been
described, including the use of Dormia baskets, rat-tooth forceps, a balloon,
or Soehendra-type stent retrievers [2]. This paper
presents a new technique for the retrieval of proximally migrated plastic
biliary stents.
A 77-year-old woman with mental retardation since childhood was
admitted to hospital with symptoms of jaundice associated with the dilation of
the secondary biliary tract and a neoplastic lesion in the head of pancreas,
rejected for surgery. Endoscopic retrograde cholangiopancreatography (ERCP)
confirmed the existence of a short stenosis of the distal bile duct; therefore,
following cytological examination, a 5-cm 10-Fr plastic stent was inserted.
After 3 months, the patient was readmitted with jaundice. A second ERCP was
carried out, revealing the earlier sphincterotomy but not the distal extreme of
the stent in the papilla. Endoscopy showed that the stent had migrated
proximally, and also revealed apparently neoplastic distal stenosis ([Fig. 1]).
Fig. 1 Fluoroscopic image of
the proximally migrated stent. The plastic stent was not visible at the
papillary orifice because it was positioned within the biliary tree.
Various attempts to retrieve the stent using a Dormia basket,
balloon and foreign-body forceps were unsuccessful. The decision was made to
insert a 10 × 40 covered self-expanding stent in order to
enlarge the stenosis to facilitate further attempts at retrieval. The proximal
end of the stent was positioned at the proximal edge of the stenosis ([Fig. 2]).
Fig. 2 A second covered
self-expanding stent was inserted, and the plastic migrated one was removed
through its lumen.
Finally, the migrated plastic stent was successfully and easily
removed via the lumen of the metallic stent using rat-tooth forceps ([Fig. 3]).
Fig. 3 Endoscopic image of the
plastic stent appearing through the metallic stent lumen.
The metallic stent was left in place in order to resolve the
jaundice, as palliative treatment. There was a progressive improvement in the
patient’s condition and bilirubin levels returned to normal limits in a
few days.
To our knowledge, our technique has not been described previously
and is relatively simple and safe. We believe it could be a feasible technique
for retrieving proximally migrated plastic stents, particularly for cases in
which more definitive palliative treatment is required.
Endoscopy_UCTN_Code_TTT_1AR_2AZ
