Single-step retrieval of a proximally migrated biliary stent

Endoscopic biliary stent placement is a well-established procedure for biliary drainage. However, it has been shown that approximately 5 % of plastic stents placed in the biliary tract migrate proximally [1]. The endoscopic retrieval of a proximally migrated biliary stent is technically challenging and occasionally unsuccessful. Several techniques for retrieving proximally migrated plastic stents have been reported [2]. We report here a novel retrieval technique, in which a biliary dilation balloon was used to pull out in one step a trapped plastic stent, previously placed to treat an anastomotic biliary stricture in a patient with a liver transplant.

A 0.035-inch guidewire (Acrobat; Cook Ireland Ltd., Limerick, Ireland) was passed through the 10-Fr, 9-cm proximally migrated stent (Cotton-Leung; Cook Ireland Ltd.) ([Fig. 1 a, b]). A dilation balloon with a diameter of 4 mm and a length of 4 cm (Hurricane RX Biliary Balloon Dilatation Catheter; Boston Scientific, Marlborough, Massachusetts, USA) was coaxially inserted over the guidewire and advanced to the distal portion of the stent ([Fig. 1 c]). It was then inflated to nominal pressure. The inflated balloon was anchored inside the stent, resulting in a firm, retrievable coaxial system. With the elevator of the scope (TJF-Q180V; Olympus Europa, Hamburg, Germany) completely opened, the balloon–stent system was withdrawn through the operative channel (diameter of 4.2 mm) ([Fig. 1 d, e]), with the guidewire left in situ for any further applications that might be needed ([Fig. 1 f]).

Fig. 1 X-ray views of the process of retrieving a proximally migrated stent: a, b 0.035-inch guidewire passed through the proximally migrated stent; c dilation balloon inserted over the guidewire and advanced to the distal portion of the stent; d, e balloon – stent system withdrawn through the operative channel; f guidewire left in situ for any further applications needed.

Inspired by the timeless suggestions advanced by Chaurasia et al. in 1999 [2], we report an improved technique of retrieval with the use of a biliary dilation balloon instead of an extraction balloon. The technique results in the safe, single-step retrieval of a migrated stent from the bile duct directly into the endoscopist’s hand ([Fig. 2]), avoiding potential damage to the bile duct and the need for withdrawal of the duodenoscope.

Fig. 2 The retrieved stent in the endoscopist’s hand.

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• References

• 1 Johanson JF, Schmalz MJ, Geenen JE. Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 1992; 38: 341-346
• 2 Chaurasia OP, Rauws EA, Fockens P et al. Endoscopic techniques for retrieval of proximally migrated biliary stents: the Amsterdam experience. Gastrointest Endosc 1999; 50: 780-785