One-step removal of a migrated biliary plastic stent using a novel long thin dilating balloon catheter

Abstract

Figures

Abdominal radiograph showing the migrated plastic stent.

Endoscopic view showing the dislodged bile duct stent.

Photograph showing a conventional dilating balloon catheter (left) and the novel dilating balloon catheter (right).

Fluoroscopic image showing the novel long thin dilating balloon (3 mm × 6 cm) inserted into the stent’s lumen.

Photographs showing the inflated balloon expanding into the flap hole of the plastic stent, so that the balloon catheter has become integrated with the stent.

Full text

Biliary plastic stent migration in endoscopic retrograde cholangiopancreatography (ERCP)-related procedures is a complication that is occasionally encountered 1 . Techniques for removing migrated plastic stents have been reported 2 3 4 ; however, some cases are still challenging, even with the use of these techniques. Here, we report the one-step removal of a migrated plastic stent using a novel long dilating balloon.

The patient was a 59-year-old man who had undergone biliary drainage using a straight-type 7-Fr plastic stent for obstructive jaundice due to pancreatic head cancer. He was admitted with chief complaints of chills and right upper quadrant abdominal pain. An abdominal radiograph showed stent migration ( Fig. 1 ), so an emergent endoscopic procedure was performed. Endoscopic examination confirmed that the stent had become dislodged into the bile duct ( Fig. 2 ), so we therefore attempted stent removal. The bile duct was cannulated, and cholangiography showed a distal bile duct stricture. After endoscopic sphincterotomy had been performed, we tried but failed to grasp the distal end of the stent with grasping forceps under fluoroscopic guidance. A stone extraction balloon catheter was advanced to the bile duct, but could not be advanced beyond the stricture owing to the migrated stent.

Abdominal radiograph showing the migrated plastic stent.

Endoscopic view showing the dislodged bile duct stent.

We next attempted to use a novel long thin dilating balloon catheter (3 mm × 6 cm; REN Biliary Dilation Catheter; Kaneka Medix, Osaka, Japan) ( Fig. 3 ) 5 . First, another guidewire (0.025-inch straight type) was advanced through the stent’s lumen under fluoroscopic guidance. The novel dilating balloon catheter was then inserted into the stent’s lumen ( Fig. 4 ) and inflated. The balloon catheter was next pulled gently and slowly backward, with the plastic stent finally being successfully removed through the scope without further difficulty ( Video 1 ). Removal was achieved as the inflated balloon expands into the flap hole, so that the balloon catheter becomes integrated with the plastic stent ( Fig. 5 ).

Photograph showing a conventional dilating balloon catheter (left) and the novel dilating balloon catheter (right).

Fluoroscopic image showing the novel long thin dilating balloon (3 mm × 6 cm) inserted into the stent’s lumen.

One-step removal of a migrated biliary plastic stent using a novel long thin dilating balloon.Video 1

Photographs showing the inflated balloon expanding into the flap hole of the plastic stent, so that the balloon catheter has become integrated with the stent.

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