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[Proximal migration of biliary prosthesis. Endoscopic extraction techniques]
G Alfredo1, A Raúl, R Barinagarrementeria
1Departamento de Endoscopia Digestiva, Hospital de Especialidades No 71, IMSS, Blvd. Revolución y Calle No 26, C.P. 27000, Torreón, Coahuila.
Background:
Proximal migration of a biliary stent is an uncommon event, but its management can present a technical challenge to the therapeutic endoscopist.
Objective:
We reviewed the methods that have been used for retrieval of proximally migrated biliary stents in a referral endoscopic center. PATIENTS-METHOD, AND RESULTS: From January 1995 to December 1998, there were 410 procedures for insertion of biliary stents. Eighteen patients had migrated biliary stents; 15 stents (83%) were extracted successfully. One half of the stents were retrieved by grasping the stent directly with a wire basket. Four were recovered using the Soehendra device, and a stone retrieval balloon alongside the stents to provide traction indirectly in two patients. Surgical techniques were necessary in three cases.
Conclusions:
In patients with a dilated duct, indirect traction with a balloon or direct grasping of the stent with a wire basket is usually successful. Cannulating the stent lumen with a wire is often the best approach in patients with biliary stricture or nondilated duct. Using these techniques, most proximally migrated biliary stents can be retrieved endoscopically.