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Video of Issue Endoscopic removal of a deteriorated fully-covered self-expandable metal stent using an endoscopic retrograde cholangiopancreatography guide sheath
Tsuyoshi Suda,orcid, Kosuke Satomura, Miyabi Miura, Kiichiro Kaji, Kuniaki Arai, Shuichi Terasaki

DOI: https://doi.org/10.5946/ce.2024.170
Published online: November 5, 2024

Department of Gastroenterology, Kanazawa Red Cross Hospital, Kanazawa, Japan

Correspondence: Tsuyoshi Suda Department of Gastroenterology, Kanazawa Red Cross Hospital, 2-251 Minma, Kanazawa, Ishikawa 921-8162, Japan E-mail: t.suda1112@gmail.com
• Received: June 26, 2024   • Revised: July 14, 2024   • Accepted: July 15, 2024

© 2024 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A 73-year-old woman with unresectable pancreatic cancer underwent chemotherapy. A fully-covered self-expandable metal stent (FCSEMS) was inserted to the common bile duct because of a malignant bile duct stricture (Fig. 1A, B). Although chemotherapy was effective, she developed recurrent biliary obstruction and was admitted for FCSEMS replacement. Endoscopic retrograde cholangiopancreatography revealed a near-complete obstruction of the FCSEMS lumen (8 mm×8 cm, BONASTENT; Standard Sci-Tech Inc.), inserted over one year previously by sludge. We failed to remove the FCSEMS using a snare, with the lower end cover being removed during the extraction (Fig. 1C). Although unclear, the cause underlying this complication was attributed to the deterioration of the FCSEMS. A guide sheath system (UMIDAS Sheath Cannula; UMIDAS) was used to remove the FCSEMS and was inserted to the bile duct, and the tip of the FCSEMS was grasped using biopsy forceps (Radial Jaw 4P; Boston Scientific) (Fig. 2A). Subsequently, the stent was detached from the bile duct wall via inversion (Fig. 2B). The lower end of the stent was grasped using forceps and pulled into the endoscope for removal (Fig. 2C, Video 1). Upon removal, damage to the lower end cover of the FCSEMS and sludge accumulation were observed (Fig. 2D). The guide sheath system was initially developed for selective pancreaticobiliary biopsy.1 However, this system has reportedly been used to remove migrated or stray bile duct stents.2 Inversion techniques have been reported in removing migrated or difficult-to-remove metallic bile duct stents.3 This study reports the safe and stable retrieval of a difficult-to-remove deteriorated FCSEMS using inversion techniques through the guide sheath system.
Video 1. The endoscopic retrograde cholangiopancreatography guide sheath enables the removal of a deteriorated fully-covered self-expandable metal stent from the bile duct wall through inversion techniques.
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A video related to this article can be found online at https://doi.org/10.5946/ce.2024.170.
Fig. 1.
(A, B) Fully-covered self-expandable metal stent (FCSEMS) on computed tomography. (C) FCSEMS with cover section damaged and metallic portion exposed.
ce-2024-170f1.jpg
Fig. 2.
(A) Biopsy forceps inserted through the guide sheath system. (B) Biopsy forceps grasping the upper end of the fully-covered self-expandable metal stent (FCSEMS) through inversion. (C) Successful FCSEMS removal. (D) Post- removal FCSEMS.
ce-2024-170f2.jpg
  • 1. Kawakami H, Uchiyama N, Hatada H, et al. Newly developed dedicated guide sheath system for selective pancreatobiliary biopsy. Dig Endosc 2023;35:e100–e102.ArticlePubMed
  • 2. Yamamoto K, Tsuchiya T, Tanaka R, et al. Endoscopic retrieval of a proximally migrated fully covered self-expandable metal stent using biopsy forceps with a guiding sheath cannula. J Hepatobiliary Pancreat Sci 2023;30:e81–e83.ArticlePubMed
  • 3. Rahimi E, Khuwaja S, Thosani N. Removal of a migrated fully covered metal biliary stent by cholangioscope-assisted inversion technique. Endoscopy 2018;50:E312–E313.ArticlePubMed

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      Endoscopic removal of a deteriorated fully-covered self-expandable metal stent using an endoscopic retrograde cholangiopancreatography guide sheath
      Image Image
      Fig. 1. (A, B) Fully-covered self-expandable metal stent (FCSEMS) on computed tomography. (C) FCSEMS with cover section damaged and metallic portion exposed.
      Fig. 2. (A) Biopsy forceps inserted through the guide sheath system. (B) Biopsy forceps grasping the upper end of the fully-covered self-expandable metal stent (FCSEMS) through inversion. (C) Successful FCSEMS removal. (D) Post- removal FCSEMS.

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      Endoscopic removal of a deteriorated fully-covered self-expandable metal stent using an endoscopic retrograde cholangiopancreatography guide sheath
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