Successful endoscopic retrieval of an embedded biliary stent using an intra‐stent balloon inflation technique assisted by direct per‐oral cholangioscopy
Successful endoscopic retrieval of an embedded biliary stent using an intra‐stent balloon inflation technique assisted by direct per‐oral cholangioscopy
复制标题
在直接经口胆管镜检查的辅助下，使用支架内球囊充气技术成功内窥镜取出嵌入式胆道支架
DOI：
10.1111/den.13981
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发表时间：
2021
影响因子：
5.3
通讯作者：
T. Oono
中科院分区：
文献类型：
--
作者：
N. Fujimori;S. Yasumori;T. Oono
一位41岁女性，因活体供肝移植后胆管狭窄，在乳头上方放置两个8.5F内支架，接受内窥镜逆行胰胆管造影术(ERCP)进行支架置换。虽然一个支架可以很容易地移除，但第二个支架是不可移除的，尽管使用了各种装置(图1a，b)。附着在支架上的尼龙线被撕裂，支架的远端在几次失败的回收尝试后断裂，因为支架的瓣被牢固地嵌入狭窄处。由于患者胆道较宽，在透视引导下将导丝插入支架也是不可能的。5天后，我们再次行ERCP，将数字胆道镜(SpyGlass DS；波士顿科学公司，马萨诸塞州马尔伯勒)插入胆管，从而显示支架的断端。使用SpyBite无法取出支架；因此，我们在直接可视化下将一根0.025英寸的导丝插入支架。Soehendra支架取回器和导丝上方的篮形导管对于支架取出无效(图1c-e)。最后，我们提出了一种锥形细球囊导管(直径4毫米的REN，日本大阪的Kaneka Medical)，将其充气到支架中。统一的球囊支架系统被成功取出，没有任何不良事件(图1f，视频S1)。以前，使用篮形导管、圈套、钳子、球囊导管或支架取回器的各种技术已被用于内窥镜下取回移位的胆道支架。我们使用的支架内球囊扩张技术可能是各种方法中牵引力最强的，因为统一的支架和球囊很容易在支架取出的方向上对齐。虽然胆道镜检查的一个缺点是成本较高，但对于胆道较宽的患者，当难以将导丝插入移位支架时，直接胆道镜辅助可能是取回支架的最佳选择。作者声明本文没有利益冲突。
A41-YEAR-OLD WOMAN with two 8.5F inside stents placed above the papilla for the biliary stricture after living donor liver transplantation underwent endoscopic retrograde cholangiopancreatography (ERCP) for stent exchange. Although one stent was easily removed, the second stent was irremovable despite the use of various devices (Figure 1a,b). The nylon thread attached to the stent was torn, and the stent’s distal end was broken after several unsuccessful retrieval attempts as its flap was strongly embedded in the stricture. The insertion of a guidewire into the stent under fluoroscopic guidance was also impossible due to the patient’s wide biliary tract. We performed ERCP again 5 days later by inserting a digital cholangioscope (SpyGlass DS; Boston Scientific, Marlborough, MA) into the bile duct, thus visualizing the broken end of the stent. The stent could not be retrieved using SpyBite; therefore, we advanced a 0.025-inch guidewire into the stent under direct visualization. Soehendra stent retriever and basket catheter over the guidewire were ineffective for stent retrieval (Figure 1c–e). Finally, we advanced a tapered thin balloon catheter (4-mm-diameter REN; Kaneka Medical, Osaka, Japan), inflating it in the stent. The unified balloon-stent system was successfully removed without any adverse events (Figure 1f, Video S1). Previously, various techniques using a basket catheter, snare, forceps, balloon catheter, or stent retriever have been employed for endoscopic retrieval of migrated biliary stents. The intra-stent balloon inflation technique that we used may have the strongest traction among various methods because the unified stent and balloon align easily in the direction of stent removal. Although one disadvantage of cholangioscopy is its high cost, direct cholangioscopy assistance could be the best option for the retrieval of a stent when the insertion of a guidewire into the migrated stent is difficult in patients with a wide biliary tract. Authors declare no conflict of interest for this article.