Post written by Moamen Gabr, MD, MSc, from the Division of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky.

A 72-year-old male with diagnosis of pancreatic head adenocarcinoma requiring endoscopic biliary stent placement 2 weeks prior to admission presented with signs of biliary obstruction. Imaging showed proximal migration of a previously placed biliary stent.

We were unable to remove the stent with extraction balloon or forceps under fluoroscopy. We were able to visualize the migrated stent with cholangioscopy but did not have a compatible snare available. We modified a standard polypectomy snare by removing the outer plastic sheath. The bare snare wire was placed through the cholangioscope, which acted as an outer sheath. The snare functioned as intended, and we were able to successfully remove the migrated plastic biliary stent.   

This case represents a difficult situation that many endoscopists will encounter. We wanted others to be able replicate our equipment modifications, if they are ever in a situation that requires it.  More importantly, we hope to inspire others to look for unconventional solutions in difficult cases.

The careful modification of endoscopic tools can increase their versatility and allow for compatibility with otherwise incompatible devices. 

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