Removal of proximally migrated biliary stents by using single-operator cholangioscopy

Lehibi, Abed Al; Mtawa, Abdullah Al; Almasoudi, Thamer; Ghamdi, Adel Al; Otaibi, Nawwaf Al; Balkhi, Areej Al

doi:10.1016/j.vgie.2020.01.001

Cited by 14 publications

(11 citation statements)

References 13 publications

(14 reference statements)

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“…1,2 The use of a retrieval snare, also known as a Spysnare, has been shown to be useful in retrieving migrated biliary stents. 3,4 This present case shows that a retrieval snare with POP can be successfully used to grasp and remove a lodged PD stone.…”

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confidence: 74%

Removal of a lodged pancreatic duct stone using a retrieval snare

Rahimi

Thosani

2020

VideoGIE

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A 63-year-old man with chronic calcific pancreatitis and a history of pancreatic duct (PD) stones was referred for recurrent chronic upper abdominal pain. He had previously undergone extracorporeal shockwave lithotripsy and ERCP with stone removal and stents that were removed a few years prior at outside facilities. CT and EUS showed pancreatic parenchymal chronic pancreatitis changes and recurrent PD stones (Fig. 1).ERCP was performed for PD stone removal. On pancreatography, the main PD was ectatic and dilated, especially in the head of the pancreas, giving a sac-like appearance, along with dilated side branches and a dominant duct of Santorini. There was a 10-mm oval filling defect consistent with a PD stone in the ectatic dilated portion of the main PD (Fig. 2). Balloon extraction was able to remove only small white stones; however, the 10-mm stone was persistently lodged in the sac-like portion on balloon sweep.A 1.5-cm retrieval basket was used; however, the basket would not fully open because it would enter a side branch in the head of the pancreas or the narrower upstream duct despite attempted opening in the proximal head of the pancreas. Peroral pancreatoscopy (POP) was then performed in attempt at laser lithotripsy (LL) of the lodged PD stone. LL proved difficult because only a portion of

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confidence: 74%

Removal of a lodged pancreatic duct stone using a retrieval snare

Rahimi

Thosani

2020

VideoGIE

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“…In these situations, advanced endoscopic techniques are necessary, such as the guide-wire technique into the stent lumen with balloon dilation and extraction (12,13). Recently, cholangioscopy assisted procedures have been described with good results (14). However, cholangioscopy equipment is expensive and not always available.…”

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confidence: 99%

Combined Endoscopic-Radiologic Minimally Invasive Rescue Technique for the Removal of a Migrated and Embedded Biliary Metal Stent

Antypas¹,

Corona²,

Boru³

et al. 2021

SGO

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Bile duct injuries represent a rare but potentially serious complication after laparoscopic cholecystectomy, that often need multidisciplinary therapeutic approaches. Additionally, post cholecystectomy clip migration into the biliary tree has been described, mainly because of local inflammatory processes. We present a case of a 65-year-old male with a bile duct injury and stricture after laparoscopic cholecystectomy treated endoscopically with sphincterotomy and stent positioning; initially with a plastic 10Fr stent and later with a totally covered metal stent. At the removal, the metal stent appeared proximally migrated and embedded with a surgical clip, the latter also migrated into the bile duct. The endoscopic retrieval of the stent was unsuccessful and thus a simultaneous right percutaneous transhepatic approach was adopted to liberate the stent and to facilitate the endoscopic procedure. The combined endoscopic-radiologic minimally-invasive approach seemed to be an effective and safe rescue technique, avoiding in this way complex surgical procedures.

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“… 2 It is mostly asymptomatic and often detected during ERCP. 2 , 3 However, adverse events can occur, including acute cholangitis, jaundice, intestinal obstruction and perforation, acute appendicitis, fistula formation, pneumonitis, and hepatic perforation. 2 Therefore, when detected, a migrated stent should be removed.…”

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confidence: 99%