Cholangioscopy-guided retrieval of a migrated stent using a novel thin cholangioscope in a patient with Roux-en-Y gastrectomy

Abstract

Figures

A thin cholangioscope (eyeMAX; Micro-Tech, China) measuring 219 cm in length, with a diameter of 9-Fr.

Computed tomography revealing multiple large stones in the common bile duct (red arrow).

Findings of endoscopic retrograde cholangiopancreatography-related procedures. a and b Cholangioscopy revealing cholangioscopy-guided lithotripsy using a novel thin cholangioscope. Successful stone fragmentation was achieved. c and d Endoscopic and fluoroscopic findings revealing plastic stent placement due to the presence of residual stones.

Cholangiography revealing the plastic stent migrated into the bile duct (red arrow).

Cholangioscopic and endoscopic findings for stent retrieval. a Cholangioscopy revealing the migrated stent in the bile duct. b The retrieval basket (SpyGlass Retrieval Basket; Boston Scientific, USA), which can be inserted through the thin cholangioscope. c Cholangioscopy revealing the successful grasping of the stent flap. d Endoscopic findings revealing successful stent retrieval of a migrated stent.

Full text

Stent migration can occur after endoscopic retrograde cholangiopancreatography (ERCP)-related procedures. Although various retrieval techniques have been reported 1 2 , removing a migrated stent remains technically challenging, particularly in patients with Roux-en-Y gastrectomy using a balloon enteroscope. Recently, a novel thin cholangioscope (eyeMAX; Micro-Tech, China), with a length of 219 cm and a diameter of 9-Fr ( Fig. 1 ), has enabled cholangioscopy-guided interventions to be performed under balloon enteroscopy 3 4 . We report a case of the successful cholangioscopy-guided retrieval of a migrated stent using a novel thin cholangioscope in a patient with Roux-en-Y gastrectomy.

A thin cholangioscope (eyeMAX; Micro-Tech, China) measuring 219 cm in length, with a diameter of 9-Fr.

A 74-year-old man with multiple large stones in the common bile duct, who had previously undergone Roux-en-Y gastrectomy, was referred to us ( Fig. 2 ). ERCP was performed using a short-type single-balloon enteroscopy (SIF-H290; Olympus Marketing, Japan) with a working length of 152 cm and a working channel of 3.2 mm in diameter 5 . Cholangioscopy-guided lithotripsy using a novel thin cholangioscope was performed, followed by the placement of a plastic stent due to the presence of residual stones ( Fig. 3 ). Two months later, residual stone extraction was attempted; however, upon reaching the papilla, the plastic stent was found to have migrated into the bile duct ( Fig. 4 ). Because fluoroscopy-guided stent retrieval using a basket catheter or a balloon catheter was unsuccessful, cholangioscopy-guided stent retrieval was attempted ( Video 1 ). The migrated stent was clearly visualized under cholangioscopy ( Fig. 5 a ). Therefore, we decided to capture the stent using a retrieval basket (SpyGlass Retrieval Basket; Boston Scientific, USA; Fig. 5 b ), which can be inserted through the thin cholangioscope. A distal flap of the stent was successfully grasped under direct cholangioscopic visualization ( Fig. 5 c ). Finally, a stent retrieval was achieved ( Fig. 5 d ).

Computed tomography revealing multiple large stones in the common bile duct (red arrow).

Findings of endoscopic retrograde cholangiopancreatography-related procedures. a and b Cholangioscopy revealing cholangioscopy-guided lithotripsy using a novel thin cholangioscope. Successful stone fragmentation was achieved. c and d Endoscopic and fluoroscopic findings revealing plastic stent placement due to the presence of residual stones.

Cholangiography revealing the plastic stent migrated into the bile duct (red arrow).

Successful cholangioscopy-guided retrieval of a migrated stent using a novel thin cholangioscope in a patient with Roux-en-Y gastrectomy.Video 1

Cholangioscopic and endoscopic findings for stent retrieval. a Cholangioscopy revealing the migrated stent in the bile duct. b The retrieval basket (SpyGlass Retrieval Basket; Boston Scientific, USA), which can be inserted through the thin cholangioscope. c Cholangioscopy revealing the successful grasping of the stent flap. d Endoscopic findings revealing successful stent retrieval of a migrated stent.

Since the retrieval of a migrated stent using a balloon enteroscope is technically challenging, cholangioscopy-guided retrieval with a novel thin cholangioscope is highly beneficial in such cases.

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