Percutaneous biliary stent removal for benign biliary stricture post hepaticojejunostomy

Area of Science:

• Gastroenterology and Hepatology
• Interventional Radiology
• Surgical Innovation

Background:

• Benign biliary strictures pose management challenges, particularly after complex surgeries like liver transplantation and Whipple procedures.
• Endoscopic retrograde cholangiopancreatography (ERCP) is often the first-line treatment, but can be limited by anatomical complexities.
• Percutaneous approaches offer an alternative when endoscopic access or treatment is not feasible.

Observation:

• A case report detailing the percutaneous extraction of a biliary stent in a patient with a history of liver transplant and Whipple procedure.
• The patient presented with benign biliary stricture post hepaticojejunostomy, unresponsive to conventional management.
• A fully covered WallFlex biliary stent was successfully placed percutaneously and subsequently removed using a balloon catheter technique.

Findings:

• The percutaneous stent extraction procedure was technically successful, achieving anastomosis patency.
• The technique provided a drain-free outcome, avoiding the need for external drainage.
• No procedural complications were observed, highlighting the safety of the approach.

Implications:

• This case demonstrates the efficacy of percutaneous biliary stent removal as a minimally invasive option for complex benign biliary strictures.
• It offers a valuable alternative to endoscopic management in challenging anatomies, particularly post-hepaticojejunostomy.
• The findings contribute to the limited literature on percutaneous stent removal, underscoring its potential in difficult clinical scenarios.