Successful endoscopic retrieval of a plastic gallbladder stent that had completely migrated into the gallbladder

Endoscopic gallbladder stenting is a useful transpapillary drainage technique for acute cholecystitis, especially in patients who are poor candidates for cholecystectomy or percutaneous gallbladder drainage. However, long-term placement may cause late adverse events, including migration. Complete migration of a gallbladder stent into the gallbladder is rare and may make retrieval challenging. A 77-year-old woman was referred to our hospital with epigastric pain. Imaging studies suggested biliary tract inflammation with gallbladder debris and bile duct dilatation, but no gallstones or common bile duct stones. Because her condition showed insufficient improvement with antibiotics, a transpapillary biliary stent and a transpapillary gallbladder stent were placed endoscopically. Her symptoms and laboratory data improved after stenting. One year later, the distal end of the gallbladder stent had migrated from the duodenum into the common bile duct. Fifteen months after treatment, the stent had completely migrated into the gallbladder. Because symptoms of biliary infection had improved and there was no indication for cholecystectomy, endoscopic retrieval was attempted. After cystic duct cannulation, bile aspiration was performed to reduce gallbladder volume. A guidewire was placed as a safety wire, and an EndoSheather was advanced into the gallbladder. The migrated stent was grasped with biopsy forceps through the sheath and gently withdrawn into the duodenum before removal through the endoscope channel. No complications occurred. Endoscopic retrieval through the cystic duct may be feasible for a gallbladder stent that has completely migrated into the gallbladder when careful wire access, bile aspiration, safety-wire placement, and sheath-assisted forceps manipulation are used.