Proximal migration often occurs as an adverse event of biliary stent placement, with
a reported migration rate of 3.1 % – 4.9 % [1]. Although various techniques have been reported for endoscopic removal of proximally
migrated biliary stents, the procedure is still technically demanding and time-consuming,
and occasionally unsuccessful [2]
[3]
[4]. We describe a useful technique for endoscopic removal of a proximally migrated
biliary stent using a novel gooseneck snare ([Fig. 1]).
Fig. 1 The novel snare has a microsnare loop that forms a 90° angle like a gooseneck (EndoCowboy;
Piolax Medical Devices, Kanagawa, Japan).
A man in his 70 s who had undergone placement of a 7-Fr straight plastic stent for
benign biliary stricture was admitted to retrieve or exchange the stent; however,
we noticed during endoscopic retrograde cholangiopancreatography (ERCP) that the stent
had migrated proximally into the common bile duct ([Fig. 2 a]). To remove the stent, biliary wire-guided cannulation was first performed, with
the cannula (MTW Endoskopie, Wesel, Germany) being inserted near the distal end of
the stent. After the guidewire had been removed, a gooseneck snare (EndoCowboy; loop
width 9 mm; Piolax Medical Devices, Kanagawa, Japan) was inserted through the lumen
of the prepositioned cannula ([Fig. 2 b]). Once the snare loop had been passed over the stent, the snare was pulled tight,
grasping the stent ([Fig. 2 c]). Finally, the cannula and snare were simultaneously pulled down and the stent was
successfully removed though the scope with no adverse events ([Video 1]).
Fig. 2 Radiographic images during endoscopic retrograde cholangiopancreatography showing:
a the previously placed 7-Fr plastic stent that had migrated proximally into the common
bile duct; b a gooseneck snare that was inserted through the lumen of a prepositioned cannula;
c the stent, which had been grasped by the snare loop, being pulled down and removed.
Video 1 A gooseneck snare is inserted through the lumen of the prepositioned cannula and
the loop is passed over the stent, before the snare is pulled tight, grasping the
stent. Finally, the cannula and snare are simultaneously pulled down and the stent
is successfully removed.
A gooseneck snare has a microsnare loop forming a 90° angle just after exiting the
outer sheath. It is useful for retrieving and manipulating foreign objects in the
cardiovascular system [5], but until now there have been no devices for endoscopic use. The EndoCowboy was
developed for ERCP. Its 2700-mm length is suitable for an endoscopic device, and various
loop sizes are available to suit the diameter of the bile duct. This novel gooseneck
snare can therefore be a useful option for the removal of proximally migrated stents
and is recommended to have on standby.
Endoscopy_UCTN_Code_TTT_1AR_2AZ
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high quality video and all
contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
