Endoscopic extraction of a proximally migrated Amsterdam-type biliary endoprosthesis

Acute obstructive cholangitis due to fishbone in the common bile duct: a case report and review of the literature

Background

Choledocholithiasis is an endemic condition in the world. Although rare, foreign body migration with biliary complications needs to be considered in the differential diagnosis for patients presenting with typical symptoms even many years after cholecystectomy, EPCP, war-wound, foreign body ingestion or any other particular history before. It is of great clinical value as the present review may offer some help when dealing with choledocholithiasis caused by foreign bodies.

Case presentation

We reported a case of choledocholithiasis caused by fishbone from choledochoduodenal anastomosis regurgitation. Moreover, we showed up all the instances of choledocholithiasis caused by foreign bodies published until June 2018 and wrote the world’s first literature review of foreign bodies in the bile duct of 144 cases. The findings from this case suggest that the migration of fishbone can cause various consequences, one of these, as we reported here, is as a core of gallstone and a cause of choledocholithiasis.

Conclusion

The literature review declared the choledocholithiasis caused by foreign bodies prefer the wrinkly and mainly comes from three parts: postoperative complications, foreign body ingestion, and post-war complications such as bullet injury and shrapnel wound. The Jonckheere-Terpstra test indicated the ERCP was currently the treatment of choice. It is a very singular case of choledocholithiasis caused by fishbone, and the present review is the first one concerning choledocholithiasis caused by foreign bodies all over the world.

Endoscopic techniques for retrieval of proximally migrated biliary stents: the Amsterdam experience

BACKGROUND

Endoscopic retrieval of proximally migrated biliary plastic stents may be technically challenging and sometimes unsuccessful. Despite the widespread use of such stents, there are few reports on the technique for retrieval of migrated stents.

METHODS

We reviewed the records of patients who were found to have proximally migrated biliary stents during the last 3 years at a tertiary referral center. Our study analyzed the various techniques used for endoscopic retrieval and evaluated the factors influencing the choice of a particular technique.

RESULTS

Endoscopic retrieval of a proximally migrated stent was attempted in 41 patients and was successful in 37 (90%). The retrieval techniques included Dormia basket, balloon, balloon and basket, basket and ball tip catheter, forceps, and Soehendra stent retriever. The Dormia basket technique was successful in the majority of cases.

CONCLUSION

Proximally migrated biliary stents can be successfully removed endoscopically in most cases. The choice of a retrieval technique is dependent on several factors including biliary ductal dilatation, depth of stent migration, distal stent impaction and biliary stricture distal to the migrated stent. The placement of an additional stent alongside an irretrievable stent is a satisfactory alternative to retrieval.

Retrieval of distally migrated, impacted biliary endoprostheses using a novel guidewire/basket "lasso" technique

BACKGROUND

Migration of biliary endoprostheses is a recognized complication of bile duct stenting. Removing a stent that has migrated is usually straightforward, but this can be challenging when the stent is firmly impacted in the opposite wall of the duodenum or within a diverticulum. We describe a new technique for removing such impacted stents using a guidewire/basket lasso.

METHODS

To perform the lasso technique, a retrieval basket and a guidewire are passed side-by-side through the accessory channel of the duodenoscope. The basket catheter is advanced underneath the stent and the guidewire manipulated over the stent; the basket is opened and the guidewire advanced through it. Closure of the basket creates a loop around the stent that can then be removed using gentle traction.

RESULTS

The lasso technique was successfully used in three cases where other maneuvers failed.

CONCLUSIONS

Biliary endoscopists should find this technique useful for retrieval of distally migrated biliary stents that are impacted against mucosa or the wall of a diverticulum so as to prevent standard basket extraction.

Endoscopic retrieval of proximally migrated biliary and pancreatic stents: experience of a large referral center

BACKGROUND

Proximal migration of a biliary or pancreatic stent is an infrequent event but its management can be technically challenging.

METHODS

Review of all cases of proximally migrated biliary and pancreatic stents over a 10-year period at a referral pancreatic-biliary center. Data abstracted from patient records included indication for stenting, method of presentation, success of attempt, and method used. Successful methods were determined by reviewing procedure reports. Follow-up was attempted in all patients in whom stent retrieval had failed.

RESULTS

Thirty-three proximally migrated bile duct stents, and 26 proximally migrated pancreatic duct stents were identified. Most of the patients were without symptoms. Eighty-five percent of common bile duct stents and 80% of pancreatic duct stents were successfully extracted endoscopically. Seventy-one percent (34 of 48) were retrieved with a basket or balloon. Of the stents not retrieved, two patients did not return for repeat ERCP, three patients with malignant common bile duct strictures were managed with placement of a second stent, three patients with pancreatic duct stents have remained without symptoms with no further retrieval attempts, and three patients with proximally migrated pancreatic duct stents required surgery because of pain and failure of multiple endoscopic retrieval attempts.

CONCLUSION

Over 80% of proximally migrated bile duct and pancreatic duct stents may be extracted endoscopically. Few patients will require surgery.

Proximal migration of biliary stents: attempted endoscopic retrieval in forty-one patients

BACKGROUND

Proximal migration of a biliary stent is an uncommon event, but its management can present a technical challenge to the therapeutic endoscopist.

METHODS

We reviewed the methods that have been used for retrieval of proximally migrated biliary stents in a referral endoscopy center.

RESULTS

Forty-four cases were identified; 38 stents (86%) were extracted successfully. Half of the stents were retrieved after first passing a guide wire through the stent lumen. Various accessories were then used to withdraw the stents, the Soehendra device being the most popular. Nearly one third were retrieved by grasping the stents directly, usually with a wire basket or forceps. The remainder were recovered after using a stone retrieval balloon alongside the stents to provide traction indirectly. Interventional radiology techniques were needed in two cases, and surgery in one.

CONCLUSIONS

Cannulating the stent lumen with a wire is often the best approach in patients with a biliary stricture or a nondilated duct. An over-the-wire accessory can then be used to secure the stent. In patients with a dilated duct, indirect traction with a balloon or direct grasping of the stent with a wire basket, snare, or forceps is usually successful. Using these techniques, most proximally migrated biliary stents can be retrieved endoscopically.

Endoscopic palliation for unresectable pancreatic carcinoma

Endoscopic stenting has revolutionized the palliation of malignant biliary obstruction. Individuals with biliary obstruction due to pancreatic malignancy are best managed by a team approach comprising individuals with expertise in oncology, surgery, endoscopy, and radiology. The clinical value of alleviating jaundice and associated symptoms of anorexia, pruritus, and malaise cannot be overestimated. These quality-of-life factors deserve more attention in future studies to define subgroups of patients most likely to derive benefit from the array of treatment options. Further technical improvements are required to solve the most important clinical problem of late stent occlusion. New developments such as expandable metallic stents and refinements in existing equipment and techniques have already resulted in measurable gains and hold great promise for future expansion of their use in malignant gastric outlet obstruction secondary to tumor infiltration of the duodenum. Corresponding advances are being made in the fields of percutaneous transhepatic intervention and hepatobiliary surgery such that further prospective randomized trials are necessary to define optimal therapy.

Incidence and risk factors for biliary and pancreatic stent migration

Endoprostheses are commonly used in the treatment of biliary and pancreatic disorders. The frequency of and potential risk factors for stent migration, however, remain largely unknown. From January 1986 to June 1990, 807 biliary and pancreatic stents were placed at our institution. Our study analyzed the occurrence of stent migration among the 589 stents for which follow-up data were available. Results demonstrated incidence rates of 4.9 and 5.9% for proximal (into the duct) and distal (out of the duct) biliary stent migration, respectively. Likewise, incidence rates of 5.2 and 7.5% were observed for proximal and distal pancreatic stent migration, respectively. Malignant strictures, larger diameter stents, and shorter stents were significantly associated with proximal biliary stent migration. Sphincter of Oddi dysfunction and longer stents were associated with proximal pancreatic stent migration. Migration of stents out of the common bile duct occurred more frequently in papillary stenosis. No other significant risk factors for distal migration were found. These results indicate that stent migration is an important complication. Multiple risk factors were associated with stent migration and need to be considered in the development of new stent types.