Endoscopy 2019; 51(04): S256-S257
DOI: 10.1055/s-0039-1681945
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: Stomach and small intestine ePosters
Georg Thieme Verlag KG Stuttgart · New York

A TROUBLESOME ENTEROSCOPIC ATTEMPT TO REMOVE MIGRATED BILIARY STENTS IN THE SMALL BOWEL IN A PATIENT WITH ALTERED ANATOMY

P Cortegoso Valdivia
1   University Division of Gastroenterology, Department of Medical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
,
L Venezia
1   University Division of Gastroenterology, Department of Medical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
,
M Pennazio
1   University Division of Gastroenterology, Department of Medical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

The management of migrated stents is variable and is generally dictated by the site, type of stent, and anticipated likelihood of complications. Enteroscopy can be useful for stents migrated deeply in the small bowel, although very challenging especially in patients with altered anatomy.

Methods:

We describe a case of a patient undergoing single balloon enteroscopy (SBE) through a LAMS, placed by EUS-guided gastro-jejunostomy in a Roux-en-Y reconstruction, in order to remove two migrated biliary stents.

Results:

In 2015 the patient underwent a left hepatectomy + bilio-jejunal Roux-en-Y anastomosis for infiltrating cholangiocarcinoma.

After few months the disease recurred, followed by relapsing episodes of cholangitis, treated with percutaneous drainage (2 metal stents) and intraluminal brachytherapy. Due to the complications of percutaneous approach (fever, subcutaneous abscess) an ERCP through a EUS-guided gastro-jejunostomy (Hot Axios stent, 15 × 10 mm) was performed, placing two metal stents inside the previously placed ones. The patient was then asymptomatic, but after one month an abdominal X-ray showed migration in the small bowel of two biliary stents. An antegrade SBE (Olympus XSIF-180-JY) was then performed through the gastro-jejunal anastomosis, inside the LAMS: after 10 push-pull cycles the two stents were found, with their proximal flange deeply buried into the mucosa of the distal jejunum with granulation tissue. Several attempts of removal with rat-tooth grasping forceps and polypectomy snare, after injection of saline were unsuccessful. Considering the high risk of perforation related to removal, the small bowel patency, the absence of symptoms and the poor patient's prognosis, the stents were left in situ and a close follow-up was scheduled. No procedural complications occurred.

Conclusions:

Enteroscopy is a safe and feasible procedure, even in cases of surgically altered anatomy. EUS-guided gastrointestinal anastomoses with LAMS may facilitate deep enteroscopic intubation for removing migrated stents A careful balance of the risks and benefits of the procedure is mandatory.