Retrieval of distally migrated, impacted biliary endoprostheses using a novel guidewire/basket "lasso" technique

Abstract

Background: Migration of biliary endoprostheses is a recognized complication of bile duct stenting. Removing a stent that has migrated is usually straightforward, but this can be challenging when the stent is firmly impacted in the opposite wall of the duodenum or within a diverticulum. We describe a new technique for removing such impacted stents using a guidewire/basket lasso.

Methods: To perform the lasso technique, a retrieval basket and a guidewire are passed side-by-side through the accessory channel of the duodenoscope. The basket catheter is advanced underneath the stent and the guidewire manipulated over the stent; the basket is opened and the guidewire advanced through it. Closure of the basket creates a loop around the stent that can then be removed using gentle traction.

Results: The lasso technique was successfully used in three cases where other maneuvers failed.

Conclusions: Biliary endoscopists should find this technique useful for retrieval of distally migrated biliary stents that are impacted against mucosa or the wall of a diverticulum so as to prevent standard basket extraction.