Endoscopic removal of a migrated stent in the gallbladder

An 84-year old man was admitted to our hospital with fever and abdominal pain. An abdominal computed tomography (CT) scan revealed evidence of acute cholecystitis ([Fig. 1]). Percutaneous transhepatic gallbladder drainage was performed and his symptoms improved; however, cholecystectomy could not be performed because the patient’s heart function was too poor.

Fig. 1 Abdominal computed tomography (CT) image showing evidence of acute cholecystitis.

To prevent him developing recurrent cholecystitis, we tried to perform endoscopic transpapillary gallbladder stenting [1] [2] [3], but owing to a crooked cystic duct, a bilateral pig-tail plastic stent (6 Fr, 10 cm) was placed in an incorrect position ([Fig. 2]).

Fig. 2 The incorrectly positioned bilateral pig-tail plastic stent.

We initially tried to retrieve the migrated stent using several types of basket; however, all of these attempts failed ([Fig. 3]). Finally, we tried to move the stent using a polypectomy snare, which consists of a single looped wire that can easily grip the tip of the stent ([Fig. 4]). Using this snare, we succeeded in smoothly placing the stent in the correct position ([Fig. 5] and [Fig. 6]).

Fig. 3 Fluoroscopic view showing an unsuccessful attempt being made to retrieve the stent using a basket.

Fig. 4 A polypectomy snare consisting of a single looped wire that can be used to easily grip the tip of the stent.

Fig. 5 Fluoroscopic views showing the stent being successfully moved into the correct position.

Fig. 6 Endoscopic view of the papilla of Vater and one end of the stent after it had been successfully repositioned.

Stent migration into the gallbladder is a rare but important condition for endoscopists.

Endoscopy_UCTN_Code_TTT_1AR_2AZ

Competing interests: None

• References

• 1 Conway JD, Russo MW, Shrestha R. Endoscopic stent insertion into the gallbladder for symptomatic gallbladder disease in patients with end stage liver disease. Gastrointest Endosc 2005; 61: 32-36
• 2 Schlenker C, Trotter JF, Shah RJ et al. Endoscopic gallbladder stent placement for treatment of symptomatic cholelithiasis in patients with end-stage liver disease. Am J Gastroenterol 2006; 101: 278-283
• 3 Lee TH, Park DH, Lee SS et al. Outcome of endoscopic transpapillary gallbladder stenting for symptomatic gallbladder disease: a multicenter prospective follow-up study. Endoscopy 2011; 43: 702-708