Single-balloon enteroscope for retrieval of migrated stent

Kei Yane, MD, from the Center for Gastroenterology, Teine-Keijinkai Hospital, in Sapporo, Japan presents this VideoGIE “Endoscopic retrieval of a proximally migrated biliary stent after pancreaticoduodenectomy by use of a short-type single-balloon enteroscope.”

Our video case describes the successful retrieval of a proximally migrated biliary stent after pancreaticoduodenectomy using a short-type single-balloon enteroscope (short SBE). A 49-year-old man underwent subtotal stomach-preserving pancreaticoduodenectomy for pancreatic cancer. Surgeons placed a 6Fr plastic biliary stent intraoperatively to decompress the choledochojejunostomy site. Four months postoperatively, the patient developed acute cholangitis. Abdominal computed tomography showed intrahepatic bile duct dilatation and proximal migration of the biliary stent. We attempted endoscopic stent retrieval using a short SBE (SIF-Y0004, Olympus Medical Systems, Tokyo, Japan; working length, 152 cm; outer diameter, 9.2 mm; working channel diameter, 3.2 mm). Endoscopic imaging showed stenosis of the choledochojejunal anastomosis. Following successful bile duct cannulation, we dilated the anastomotic site using an 8 mm balloon (Hurricane RX, Boston Scientific, Natick, MA, USA). Subsequently, we removed the stent using a conventional wire-guided retrieval basket (TetraCatch V, FG-V436P, Olympus). There were no post-procedure adverse events. The patient’s symptoms and liver function tests improved immediately after the procedure.

Figure 1. A, Abdominal CT view showing intrahepatic bile duct dilatation and proximal migration of the biliary stent (arrow). B, Removal of the stent with a conventional wire-guided retrieval basket.

Endoscopic retrieval of proximally migrated biliary stents is less invasive, but technically challenging. To the best of our knowledge, there are no detailed case reports about the endoscopic retrieval procedure of a migrated stent into the hepatic duct accompanied by choledochojejunal anastomotic stricture.

With the development of balloon-assisted enteroscopy, therapeutic biliary interventions have become possible in patients with surgically altered anatomy. However, a conventional single-balloon enteroscope has a limitation for using the ordinary ERCP accessories because of the total length and channel diameter of the scope. The larger working channel of the short SBE enables the smooth use of various ordinary instruments such as a wire-guided basket catheter or a balloon catheter. It may facilitate complex endoscopic interventions in patients with surgically altered anatomy.

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The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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