The usefulness of a dedicated hepaticogastrostomy (HGS) plastic stent (TYPE-IT stent; Gadelius Medical, Tokyo, Japan) for endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has been reported 1 2 . However, to date, no reports have been published on the inward migration of dedicated HGS plastic stents. Here, we report a rare case of post-hepaticojejunostomy, in which a dedicated HGS plastic stent placed from the stomach through the bile duct and into the jejunum had migrated entirely into the bile duct ( Video 1 ). A 43-year-old man underwent extrahepatic bile duct resection and hepaticojejunostomy for congenital biliary dilatation. Nine years later, he developed cholangitis and underwent EUS-HGS with the placement of a dedicated HGS plastic stent. An anastomotic stricture was identified between the left hepatic duct and the jejunum ( Fig. 1 ). Balloon dilation using an 8-mm balloon was performed every 3 months. In the third session, the notch of the balloon was no longer visible, indicating adequate dilation ( Fig. 2 ), and two dedicated HGS plastic stents were placed from the stomach to the jejunum across the dilated anastomotic stricture.
Fig. 1.
An anastomotic stricture was identified between the left hepatic duct and the jejunum.
Fig. 2.
In the third session, the notch of the balloon was no longer visible, indicating adequate dilation.
Reintervention for the inward migration of a dedicated HGS plastic stent into the bile duct in a patient with post-hepaticojejunostomy. HGS, hepaticogastrostomy.
Video 1
Approximately 3 months later, the patient presented with abdominal pain. Abdominal radiography revealed that one of the stents had migrated into the biliary system ( Fig. 3 ). An emergency endoscopic procedure was performed, during which a guidewire was advanced through the EUS-HGS tract, and the migrated stent was successfully removed using rotatable grasping forceps ( Fig. 4 ). Two double-pigtail plastic stents were placed, and the procedure was completed without complications. The patient recovered without further symptoms, and no additional episodes of stent migration occurred during the follow-up period. This case emphasizes that endoscopists should be cautious about the risk of inward stent migration, despite the use of dedicated HGS plastic stents specifically designed to prevent such complications.
Fig. 3.
Abdominal radiography revealed that one of the stents had migrated into the biliary system.
Fig. 4.
The migrated stent was successfully removed using the rotatable grasping forceps.
Endoscopy_UCTN_Code_CPL_1AL_2AD
Footnotes
Conflict of Interest The authors declare that they have no conflict of interest.
Contributorsʼ Statement Akito Furuta: Conceptualization, Investigation, Writing – original draft. Keijiro Ueda: Conceptualization, Investigation, Writing – review & editing. Kazuhide Matsumoto: Conceptualization, Writing – review & editing. Masatoshi Murakami: Conceptualization, Writing – review & editing. Nao Fujimori: Conceptualization, Supervision, Writing – review & editing. Yoshihiro Ogawa: Conceptualization, Writing – review & editing.
References
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