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

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.

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.

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

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.