Resident Loma Linda University Medical Center Loma Linda, CA
Mohamed Azab, MD, Shishira Bharadwaj, MD; Loma Linda University Medical Center, Loma Linda, CA
Introduction: Proximal migration of biliary stents although rare can be challenging to retrieve and can lead to life threatening complications. We report our institution's experience with endoscopic removal of migrated biliary stents using the SpyGlass retrieval snare (Boston Scientific, Marlborough, Mass, USA).
Methods: Patient 1 was a58 year old male with type IV choledochal cyst and a 1.5 cm distal CBD stricture with migrated plastic biliary stent who presented with worsening jaundice 6 weeks following index Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure. Patient 2 was a 68 year old female, 4 months post liver transplant for HCV cirrhosis complicated with anastomotic stricture. Repeat ERCP in 6 weeks following the index procedure showed migrated biliary stent. In both of these cases, initial attempts at balloon sweeps, use of rat tooth, snare and other tools were attempted, however were ultimately unsuccessful. Then a SpyGlass retrieval snare under direct cholagioscopic visualization was attempted and was successful. Discussion: Direct visualization with cholangioscopy and use of retrieval snare can be useful tools to remove a migrated plastic stent and should be a part of the ERCP armamentarium.Further studies are needed to enhance our knowledge of which patients may benefit from this modality as a first line approach.
Figure 1. shows Spy snare holding the migrating stent.
Figure 2. shows cholangiogram with migrating biliary stent.
Disclosures: Mohamed Azab indicated no relevant financial relationships. Shishira Bharadwaj indicated no relevant financial relationships.