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

Post written by Abed Al Lehibi, MD, from Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia.
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Our series included 3 patients whose cases, while being treated for difficult biliary stones, were complicated by proximal stent migration. Two patients had migrated plastic stents, whereas the other had a migrated metal one. Single-operator cholangioscopy (Boston Scientific SpyGlass™ DS) was used to retrieve the stents in all patients. The SpyBite™ biopsy forceps accessory was used to extract the metal stent. The plastic stents, on the other hand, were retrieved using the SpyBasket and the SpySnare accessories. All patients ended up with a successful stent removal with the techniques described above. In addition, all of them completed more than 4 weeks of follow-up with no reported immediate or delayed adverse events.

Migration is a rare adverse event of biliary stenting. According to the 2012 European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline, migration is reported in up to 20% of fully-covered metallic stents, 5% of plastic and partially covered metallic stents, and 1% of uncovered metallic stents.

Because infrequent adverse events do not usually receive enough attention, showcasing individual experiences can often be useful in advancing our knowledge of the available management options.

With the experience described in this case series, other endoscopists now have a few additional tools and techniques that can be helpful in managing future patients with proximally migrated biliary stents. Furthermore, successful stent removal in 1 cholangioscopy procedure can save these patients repeated removal attempts and even reduce the morbidity of surgical extraction.

Read the full article online.

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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