Open-biopsy-forceps technique for endoscopic removal of distally migrated and impacted biliary metallic stents.

ABSTRACT

BACKGROUND: Endoscopic removal of distally migrated and impacted biliary metallic stents is technically challenging. An open-biopsy-forceps technique for endoscopic removal of these migrated stents is described. METHODS: The technique was used in 4 patients with distally migrated and impacted covered metallic stents. A closed biopsy forceps was advanced through the stent mesh and opened within the stent to form an "anchor." With endoscope withdrawal, the stent was dislodged easily from the duodenum to the stomach. After grasping an end of the stent with a snare, the stent was removed by complete withdrawal of the endoscope. OBSERVATIONS In all patients, the impacted stent was removed successfully. Mean time for removal was 10.2 minutes. Although ulceration was evident in the duodenal wall where the distal stent end was impacted in all patients, no other complication or adverse event was observed. CONCLUSIONS: The open-biopsy-forceps technique is useful for endoscopic removal of distally migrated and impacted biliary metallic stents.