Post written by Samuel Han, MD, MS, from The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

In this video, we describe the use of cholangioscopy through a colonoscope to successfully retrieve a stent that had migrated into the duct during ERCP in a patient with surgically altered anatomy (Roux-en-Y hepaticojejunostomy).

After attempting conventional methods including balloon sweeping and forceps retrieval, we performed cholangioscopy to directly visualize the migrated stent. We then used the cholangioscopy-guided stone retrieval basket (SpyBasket; Boston Scientific, Marlborough, Mass, USA), retrieval snare (SpySnare; Boston Scientific), and biopsy forceps (SpyBite; Boston Scientific) to attempt removal of the stent with the forceps, ultimately allowing for successful stent retrieval.    

We felt that it was important to showcase this video as it demonstrates how migrated stents can be removed in cases of surgically altered anatomy where standard tools and techniques are not possible/amenable for stent retrieval.

We also wanted to highlight how cholangioscopy can still be performed with a colonoscope because of the long length of the cholangioscope, which can easily be forgotten during altered-anatomy ERCP.

We hope other endoscopists can see how different cholangioscopy-specific devices can be used for stent retrieval. We also would like endoscopists to understand the importance of the orientation and maneuverability of the cholangioscope, which changes as devices are passed through its working channel.

Most importantly, we want to offer additional techniques for stent retrieval when standard techniques fail.  

Initial appearance of a hepaticojejunostomy anastomotic stricture (arrow).

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