In cases of unresectable malignant hilar biliary obstruction, uncovered self-expandable
metal stent (UCSEMS) deployment using a side-by-side or stent-in-stent technique may
be recommended for the purpose of prolonging stent patency, according to a consensus
statement and guideline [1]
[2]. However, because of recent improvements in systemic chemotherapy, such as immune
checkpoint inhibitors [3], the number of reinterventions required may have increased. If a UCSEMS is deployed,
reintervention may be challenging, because the UCSEMS cannot be removed.
The technique of inside plastic stent deployment has also been developed with the
aim of obtaining longer stent patency. According to a recent meta-analysis [4], inside plastic stent deployment and UCSEMS deployment have been reported to have
similar efficacy. To remove an inside plastic stent, the thread must be grasped, but
it may break during stent removal. Yokode et al. described a technique using rotatable
grasping forceps to safely remove such stents [5]; however, the device they used has a coiled sheath, so the removal force may be
weak. Recently, a novel rotatable grasping forceps has become available (ENDO Glip;
AGS Med Tech, Tokyo, Japan) ([Fig. 1]). Unlike with conventional rotatable grasping forceps, the removal force with the
novel forceps can be transmitted directly because of its noncoiled sheath. In this
report, a screw stent removal technique using the novel grasping device is described
([Video 1]).
Fig. 1 Photograph of a novel rotatable grasping forceps (ENDO Glip; AGS Med Tech, Tokyo,
Japan).
A novel rotatable grasping forceps is used to remove an inside plastic stent, with
the thread twisting around the forceps as the forceps is rotated, leading to successful
removal of the stent without breakage of the thread.Video 1
A 71-year-old man was admitted to our hospital with recurrent biliary obstruction.
He had undergone inside plastic stent deployment for cholangiocarcinoma 6 months previously.
Therefore, reintervention under endoscopic retrograde cholangiopancreatography (ERCP)
guidance was attempted. The duodenoscope was first inserted into the second part of
the duodenum, where the thread of the inside plastic stent was identified ([Fig. 2]
a). After a 0.025-inch guidewire had been placed into the biliary tract, the thread
was grasped using the novel rotatable grasping forceps. The grasping forceps was then
rotated, with the thread twisting around the forceps ([Fig. 2]
b). This allowed the inside plastic stent to be successfully removed, without the thread
breaking ([Fig. 3]
a). Finally, a new inside plastic stent was deployed ([Fig. 3]
b).
Fig. 2 Endoscopic views showing: a visualization of the thread of the inside plastic stent; b the thread being grasped with the novel rotatable grasping forceps, which is then
rotated, with the thread gradually twisting around the forceps.
Fig. 3 Fluoroscopic images showing: a the inside plastic stent being successfully removed without the thread breaking;
b an inside plastic stent being deployed.
In conclusion, a technique using the novel rotatable grasping forceps might be useful
for the removal of inside plastic stents.
Endoscopy_UCTN_Code_TTT_1AR_2AZ
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
Group A countries and 50% waivers to those who are based in Group B countries as classified
by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
