Abstract

Self-expandable metal stents (SEMS) are widely used for the palliative treatment of unresectable malignant biliary obstruction. However, the long-term durability of SEMSs in biliary strictures is not clear. We describe a case of endoscopic removal of spontaneously fractured uncovered biliary SEMS. A 59-year-old woman presented to our institution with a 1-year history of recurrent cholangitis. Her medical history included a proctectomy for rectal cancer and right hemihepatectomy for liver metastasis 10 years earlier. Five years after these operations, she developed a benign hilar stricture and had an uncovered SEMS placed in another hospital. Endoscopic retrograde cholangiopancreatography demonstrated that the SEMS was torn in half and the distal part of the stent was floating in the dilated common bile duct. The papillary orifice was dilated by endoscopic papillary large balloon dilation (EPLBD) using a 15-mm wire-guided balloon catheter. Subsequently, we inserted biopsy forceps into the bile duct and grasped the distal end of the broken SEMS under fluoroscopy. We successfully removed the fragment of the SEMS from the bile duct, along with the endoscope. The patient was discharged without complications. Placement of an uncovered biliary SEMS is not the preferred treatment for benign biliary strictures. Spontaneous fracture of an uncovered biliary SEMS is an extremely rare complication. We should be aware that stent fracture can occur when placing uncovered biliary SEMSs in patients with a long life expectancy. EPLBD is very useful for retrieving the fractured fragment of SEMS.

Links

Publisher Full Text

Authors

Kawakubo K, Isayama H, Tsujino T, Nakai Y, Sasahira N, Kogure H, Hamada T, Nagano R, Miyabayashi K, Yamamoto K, Mohri D, Sasaki T, Ito Y, Yamamoto N, Hirano K, Tada M, Koike K

Institution

Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Source

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 24:3 2012 May pg 182-4

MeSH

Balloon Dilation
Biliary Tract Neoplasms
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis
Constriction, Pathologic
Device Removal
Endoscopy, Digestive System
Female
Humans
Middle Aged
Prosthesis Failure
Radiography, Abdominal
Stents

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22507093