Endoscopic retrieval of a proximally migrated biliary plastic stent using a guidewire loop technique.

Endoscopic biliary stent placement is a well-established technique for various indications including biliary drainage. However, it has been shown that approximately 5% of plastic stents placed in the biliary tract migrate proximally [1]. Endoscopic retrieval of proximally migrated biliary stents is technically challenging and occasionally unsuccessful. Several techniques for retrieving proximally migrated plastic stent have been reported [2,3]. We report a novel technique of retrieving a proximally migrated biliary stent using a guidewire loop technique. A 65-year-old woman visited our institution because of acute cholangitis. She had undergone cholecystectomy 2 years before this admission. Physical examination revealed fever, jaundice, and mild tenderness over the right upper quadrant. Murphy’s sign was negative. Laboratory studies demonstrated a white blood cell count of 23000/μL (normal, 4500–10000/μL), and a total bilirubin concentration of 2.7mg/dL (normal, 0.2–1.2mg/dL). The patient underwent emergent endoscopic retrograde cholangiopancreatography (ERCP) for biliary decompression. The ERCP image revealed common bile duct (CBD) dilatation with small filling defects in the distal CBD. A 7-cm, 7-Fr biliary stent was inserted. However, 2 months after the initial ERCP, the patient presented at the emergency department with fever and abdominal pain. Contrast-enhanced computed tomography of the abdomen revealed that the biliary stent had migrated proximally into the CBD (●" Fig.1). A second ERCP was undertaken to retrieve the migrated stent. A retrieval basket (FG-23Q1; Olympus Medical Systems Corporation, Tokyo, Japan) grasping the distal end of a 0.035-inch straight guidewire (Jagwire; Boston Scientific Corporation, Natick, MA, USA) was used to retrieve the migrated stent (●" Fig.2). After successful biliary cannulation, the guidewire was slightly pushed forward to form a loop within the CBD (●" Fig.3). By simultaneously pulling the retrieval basket and the guidewire backward, the distal side flap of the biliary stent was caught by the guidewire loop and the stent was successfully retrieved.