Removal of an embedded, migrated plastic biliary stent with the use of cholangioscopy

A 64-year-old man presented with painless jaundice. ERCP showed a stricture at the proximal common hepatic duct, and a 10F 15-cm biliary stent was placed. Examination of biopsy specimens revealed cholangiocarcinoma. The patient was deemed a nonsurgical candidate, and repeat ERCP was performed for revision to metal stent. During ERCP the plastic stent was noted to have migrated proximally into the left intrahepatic system, and it was embedded (Fig. 1A). Multiple attempts to remove the stent were unsuccessful despite the use of rat-tooth and alligator forceps, extraction and dilating balloons, snares, and various baskets. A cholangioscope was then inserted into the common bile duct and positioned just under the distal portion of the migrated stent. Under direct visualization, the orifice of the biliary stent was cannulated with a .035inch guidewire (Fig. 1B; Video 1, available online at www.giejournal.org). The guidewire was advanced through the stent and deep into the left intrahepatic duct. The cholangioscope was then removed over the guidewire. A stent retriever device was then advanced over the guidewire and fixed into the distal portion of the stent. The plastic stent