Post written by Abdulrahman Qatomah, MBBS, FRCPC, from Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA, and King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.

A 65-year-old woman with a history of Roux-en-Y gastric bypass presented with cholangitis secondary to a benign biliary stricture. She previously underwent placement of a percutaneously delivered vascular covered metal stent in the common bile duct. She was referred for endoscopic creation of a gastrogastrostomy followed by endoscopic retrograde cholangiopancreatography for stent removal and repeat biopsy. Multiple conventional retrieval techniques were attempted without success because of stent outer diameter and tissue overgrowth.

We then used an endoscopic balloon dissection technique with both a stone extraction balloon (Boston Scientific, Marlborough, Mass, USA) and a Hurricane dilation balloon (Boston Scientific) over a guidewire to progressively detach the stent from the surrounding biliary mucosa. Sequential circumferential balloon inflations allowed successful mobilization of the stent, which was subsequently removed with a snare.

Removal of a covered metal stent can be challenging because of tissue ingrowth and other factors. Conventional options are feasible but might not be successful. This technique is safe if conducted with caution and an addition to the endoscopist toolbox.

By carefully advancing a guidewire between the bile duct wall and the embedded stent, followed by sequential balloon inflations to dissect tissue adhesions, we were able to free and retrieve the stent safely without bleeding or ductal injury. The patient recovered well without a recurrent stricture or cholangitis.

This case highlights balloon dissection as a promising tool when conventional extraction methods fail. Although applied here to a vascular stent, the concept may extend to standard biliary fully covered self-expandable metal stents. Larger series are needed to validate safety, reproducibility, and long-term outcomes.

This article emphasizes the importance of innovation in therapeutic endoscopy when faced with unexpected device-related challenges. I hope this technique encourages future collaborative studies and provides an additional option in the armamentarium for difficult stent extractions.

Fluoroscopic images. A, Guidewire and stone extraction balloon (arrows) passed adjacent to the stent into bile duct. B, Stone extraction balloon (white arrows) positioned adjacent to the proximal part of the stent (yellow arrows). C, Inflated balloon (white arrows) detaching the proximal part of the stent (yellow arrows) from bile duct.

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