Biliary metal stent placement is commonly performed for alleviation of malignant biliary obstruction. Migration of uncovered metal biliary stents is rare but may lead to bleeding, pain, perforation, or obstruction (luminal or biliary). We present a case of a migrated uncovered biliary metal stent that was successfully managed endoscopically.
Case
A 67-year-old woman with pancreatic head carcinoma underwent uncovered metal biliary stent placement by interventional radiology at an outside facility. She presented at our institution with abdominal pain, nausea, and vomiting. CT scan of the abdomen revealed migration of the metal common bile duct stent with impaction of the distal end of the stent into the lateral duodenal wall (Fig. 1).
Figure 1.
Axial view of CT of the abdomen showing the migrated common bile duct stent in the duodenum.
The patient was scheduled for ERCP with the intent of cutting the migrated portion of the metal biliary stent (Video 1, available online at www.VideoGIE.org). Argon plasma coagulation was used to burn and cut the mid portion of the stent to approximately three-fourths of the circumference (Figure 2, Figure 3, Figure 4).
Figure 2.
Impaction of the distal end of the common bile duct stent on the lateral wall of the duodenum.
Figure 3.
Argon plasma coagulation of the migrated common bile duct stent.
Figure 4.
Complete argon plasma coagulation of the front end of the migrated common bile duct stent.
Endoscissors were used to cut the part of the stent in contiguity with the wall of the duodenum because some tissue ingrowth into the back wall of the stent was noted. The cut portion of the stent was removed with a snare via an esophageal overtube (Figs. 5 and 6). The patient’s symptoms improved after the procedure, and she was discharged home.
Figure 5.
Successful removal of the distal end of the migrated stent after argon plasma coagulation and cutting.
Figure 6.
Cholangiogram after argon plasma coagulation and cutting of the wall stent.
Conclusion
Uncovered metal biliary stents rarely migrate into the duodenal lumen. However, when they do, they can lead to abdominal pain, biliary obstruction, local ulceration, perforation, or luminal obstruction. Endoscopic management by “trimming” the redundant portion of the biliary stent is feasible using the argon plasma coagulator and endoscissors.1,2 In our patient, symptoms resolved after removal of the offending portion of the metal stent.
Disclosure
All authors disclosed no financial relationships.
Supplementary data
Burning and cutting: a unique technique for management of migrated uncovered metal biliary stents
References
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Associated Data
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Supplementary Materials
Burning and cutting: a unique technique for management of migrated uncovered metal biliary stents