Successful retrieval of migrated and embedded fully covered self-expanding metal stent using "snare and lithotripter" technique.

Abstract

A 52-year-old woman with benign perihilar left intrahepatic duct stricture underwent repeated stricture dilation and multiple plastic stent placements. Subsequently, an 8 mm × 12 cm multi-hole fully covered self-expanding metal stent (MH-FCSEMS) was inserted. Six months later, she had abnormal liver biochemistry. Endoscopic retrograde cholangiography (ERC) revealed supra-papillary stent migration and tissue ingrowth at the proximal end ([Fig. 1]). Cholangioscopy (SpyGlass System; Boston Scientific Corp., Marlborough, Massachusetts, USA) showed that the stent lumen was obliterated by stone cast ([Fig. 2]). Stent removal with forceps and snare failed. The patient was referred to our center for a second opinion.