Migration of Plastic Biliary Stents and Endoscopic Retrieval

Abstract

Retrieval of a proximally migrated stent requires experience with different endoscopic devices. Moreover, distal migration needs attention because it can cause severe complications.

New 10F soft and pliable polyurethane stents decrease the migration rate compared with conventional 10F polyethylene stents in hilar biliary obstruction: results of a pilot study

“…16 In hilar biliary strictures, longer stents were required to decompress dilated intrahepatic ducts. Longer stents that are usually used in proximal strictures often migrate distally, and shorter stents that are usually used in distal strictures often migrate proximally.…”

A Potentially Fatal Complication of Biliary Stent Migration

“…One option is to attempt endoscopic retrieval. A recent review showed that this might be difficult for proximally migrated stents (71.4% success) but was more successful for distally migrated stents (100% successfully retrieved) [4]. Indeed 80-86% success for proximal stent retrieval has also been reported but it is a technical challenge to the endoscopist [5].…”

Rare and underappreciated complications of endoscopic retrograde cholangiopancreatography

“…Proximally migrated biliary stents should be retrieved as they can cause cholangitis or jaundice if left in situ [56]. If possible, the endoscopist can attempt to directly grab the migrated stent and gently pull it out using biopsy forceps under endoscopic or fluoroscopic guidance [56,57]. If forceps are ineffective, we recommend approaching the stent much like a common bile duct stone.…”

“…A guidewire should be advanced through the lumen of the stent (if 10 F or greater) or alongside the stent and into the intrahepatic biliary tree. Then, a retrieval balloon catheter can be inserted into the stent or above it; using standard techniques of balloon stone extraction, the stent can usually be pulled below the papilla and then removed with a snare [56]. Rarely, lithotriptor baskets, polypectomy snares, and even cholangioscopy may be required if neither a forceps or retrieval balloon is effective.…”

“…However, there are no reports of distally migrated covered metallic stents causing complications within the gastrointestinal tract. Proximally migrated biliary stents should be retrieved as they can cause cholangitis or jaundice if left in situ [56]. If possible, the endoscopist can attempt to directly grab the migrated stent and gently pull it out using biopsy forceps under endoscopic or fluoroscopic guidance [56,57].…”