Spy basket retrieval method of an embedded hepaticogastrostomy stent (with videos).

Abstract

EUS-guided hepaticogastrostomy (EUS-HGS) is performed for benign biliary diseases as an alternative therapy for ERCP. However, a critical adverse event such as stent migration was reported.[1] Recently, stent retrieval method in the HGS route using Spy bite (Boston Scientific, Marlborough, Massachusetts, USA),[2] forceps,[3] or balloon[4] has been reported. We report a case that the plastic stent (PS) retrieval method using Spy basket (Boston Scientific) [Figure 1] and grasping the flap of PS was efficient as a new stent retrieval method.Figure 1: Spy basket (Boston Scientific, Marlborough, Massachusetts, USA)A 70-year-old man with a history of pancreaticoduodenectomy was admitted to our institution to treat intrahepatic biliary stones. Because we failed to remove stones under enteroscope-assisted ERCP due to the instability of the scope, we decided to perform EUS-HGS. At first, a PS was placed in the choledochojejunostomy route, and a metallic stent was placed across the HGS route due to the incomplete stone extraction because of large stone size [Video 1]. One month later, the PS was revealed to be placed into B2 [Figure 2a]. It seemed to be difficult to retrieve the PS because of embedding into not B3 but B2. After we removed the metallic stent in the HGS route, cholangioscope (Spy-Glass DS; Boston Scientific) was inserted. Although we failed to catch the PS by Spy bite under direct visualization [Video 2], we could successfully grasp the flap of embedded stent and easily retrieve it using a Spy basket [Figure 2b, c and Video 3]. Finally, stones were completely extracted using electrohydraulic lithotripsy with a cholangioscopy. No procedure-related adverse events occurred [Figure 2d]. Although stent dislocation can be a serious complication during interventional EUS and may need surgical intervention, cholangioscopy-guided grasping the flap of PS by Spy basket can be an effective method for retrieval of embedded PS.Figure 2: Retrieval of an embedded stent using a digital cholangioscopy and Spy basket; (a) An embedded plastic stent to the left lateral branch of the bile duct (B2). (b and c) The embedded stent was grasped using a Spy basket under digital cholangioscopic visualization, on the cholangioscopic image and fluoroscopic image. (d) Fluoroscopic image of the biliary duct after removal of the stent and intrahepatic biliary stonesDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.