Rescue retrieval of a migrated and fractured biliary plastic stent using a rotatable spiral basket in Roux-en-Y anatomy

Intraductal stent migration and retained fragments after stent fracture can be difficult to retrieve endoscopically. Rescue retrievals using lithotripsy devices have been reported ^{1 2} . Other extraction techniques include cholangioscopy-directed snaring or grasping and fluoroscopy-guided retrieval using snares or conventional baskets. A rotatable spiral basket catheter allows clockwise and counterclockwise rotations and standard to-and-fro manipulation, and its utility for foreign body removal has been described ( 3 4 5 , Fig. 1 ).

Fig. 1.

The structure of the rotatable spiral basket catheter. a Distal basket tip with an 8-wire spiral design (arrow); basket length, 40 mm; basket diameter, 20 mm. b An overall view of the device and the handle, which allows clockwise and counterclockwise rotations; working length, 200 cm.

An 84-year-old woman with Roux-en-Y reconstruction for gastric cancer underwent biliary drainage for acute cholangitis secondary to common bile duct stones, with the placement of two plastic stents (7-Fr, 12-cm and 7-Fr, 7-cm). After stent migration and fracture were identified, she underwent enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP; Video 1 ).

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Rotatable spiral basket rescue for a migrated biliary stent and a fractured fragment in Roux-en-Y anatomy.

Video 1

Enteroscopy-assisted ERCP using a short-type single-balloon enteroscope (SIF-H290S; Olympus, Tokyo, Japan) revealed the complete intraductal migration of the 7-Fr, 12-cm stent ( Fig. 2 a, b ). The 7-Fr, 7-cm stent had fractured on the hepatic side. The detached fragment was floating within the common bile duct ( Fig. 2 a ). Endoscopic papillary balloon dilation (8 mm) was performed ( Fig. 3 a ). Balloon sweeping was also unsuccessful owing to pronounced ductal angulation. Neither the migrated stent nor the fractured fragment could be captured ( Fig. 3 b ). Retrieval using grasping forceps failed because marked ductal dilatation prevented stable grasping ( Fig. 3 c ).

Fig. 2.

Pre-procedural fluoroscopic and endoscopic findings. a Fluoroscopy shows the complete intraductal migration of a 7-Fr, 12-cm plastic biliary stent and a free-floating intraductal fragment from a fractured 7-Fr, 7-cm stent (arrows). b An endoscopic view at the papilla shows only one stent.

Fig. 3.

Papillary dilation and failed retrieval attempts using conventional devices. a Endoscopic papillary balloon dilation was performed with an 8-mm balloon catheter. b Balloon sweeping was unsuccessful because of marked ductal angulation. c Retrieval using grasping forceps was attempted for the migrated stent and the fractured fragment but was unsuccessful.

A rotatable spiral basket catheter was then deployed within the bile duct. With several clockwise and counterclockwise rotations, the migrated stent was entangled within the spiral basket and removed ( Fig. 4 a ). The floating fractured fragment was subsequently guided into and secured within the spiral basket using the same maneuver, enabling complete retrieval ( Fig. 4 b, c ). No procedure-related adverse events occurred.

Fig. 4.

Fluoroscopic images of failed balloon retrieval and rescue retrieval using a rotatable spiral basket catheter. a The migrated 7-Fr, 12-cm stent was readily removed after several rotational maneuvers (arrow). b Balloon sweeping was also unsuccessful (arrow). c With additional rotational maneuvers, the fragment was guided into and secured within the spiral basket, enabling retrieval (arrow).

This case illustrates that a rotatable spiral basket catheter can serve as a useful rescue option in a markedly dilated and angulated bile duct during enteroscopy-assisted ERCP in surgically altered anatomy by capturing targets through an “entanglement” mechanism rather than direct grasping.

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