Rescue technique for basket impaction with a plastic stent, a rare complication of biliary inside stenting

Abstract

A basket impaction during stone extraction or plastic stent (PS) migration is a well-known complication of endoscopic retrograde cholangiopancreatography (ERCP). However, a basket impaction with a PS is rare. A 66-year-old woman with a 7F biliary inside stent (IS) for the anastomotic biliary stricture after a living donor liver transplantation underwent ERCP for IS exchange. The nylon thread attached to the IS was not found on the endoscopic image. Therefore, we inserted a rotatable 8-wire basket (RASEN; Kaneka Medical, Osaka, Japan) to retrieve the migrated IS.¹ The IS's distal flange was easily caught by the basket, and we intended to remove it. However, when attempting to extract the IS into the duodenum, the stent's distal end penetrated the oral protrusion of the duodenal papilla, apart from the orifice of the bile duct. We could not open the basket or push it upward into the common bile duct, resulting in its impaction with the PS (Fig. 1). After removing the endoscope and leaving the basket in place, we reinserted the endoscope and recannulated the bile duct. Subsequently, we performed endoscopic sphincterotomy (EST) in the direction of the impacted PS. Although there was post-EST bleeding, we grasped it with forceps after hemostasis and finally succeeded in retrieving the impacted PS (Video S1).

Various techniques, such as a basket catheter, snare, forceps, balloon catheter, or stent retriever, have been used to retrieve a migrated PS.² However, a rescue technique for an impacted PS has not been established, and complicated procedures such as mechanical lithotripsy or electrohydraulic lithotripsy with a cholangioscope³ that have been used for basket impaction with a biliary stone cannot be employed for PS impaction. Endoscopists should carefully align the PS with the direction of stent removal, and additional EST may be a treatment option for PS impaction.

Author N.F. has received consulting fees from Kaneka Medical, and payment for lectures from Gadelius Medical and Kaneka Medical. The other authors declare no conflict of interest for this article.