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DOI: 10.1055/a-1638-8983
Endoscopic ultrasound-guided stent-in-stent placement for management of migrated hepaticogastrostomy stent
Stent misdeployment or migration into the peritoneal cavity is a dreaded complication of endoscopic ultrasound (EUS)-guided hepaticogastrostomy. It occurs in around 2.5 % procedures, is potentially fatal, and usually treated surgically [1]. A few cases have been reported in which this complication was managed by repositioning the stent using transluminal endoscopic surgery techniques [2] [3] or by EUS-guided stent-in-stent insertion [4] [5]. Here we present a case of EUS-guided puncture of the migrated stent through the wall of the gastroesophageal junction followed by stent-in-stent insertion.
A 58-year-old woman with a malignant hilar obstruction, a self-expandable metal stent (SEMS) in the right hepatic duct, and a failure to drain the left hepatic duct during endoscopic retrograde cholangiography underwent EUS-guided hepaticogastrostomy with a fully covered biliary SEMS (Hanarostent BCG-10-060; M.I. Tech, Gyeonggi-do, Republic of Korea). The next day the patient developed abdominal pain and vomiting. Computed tomography (CT) revealed stent migration into abdominal cavity and a fluid collection between the stomach and left liver lobe ([Fig. 1]).
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The stent could not be identified in the hepaticogastrostomy site on endoscopy ([Fig. 2]), but it was well visible on EUS close to the wall of the gastroesophageal junction. Using fluoroscopy control of the echoendoscope tip position and EUS guidance, the proximal end of the stent was punctured with a 19G needle (EasyShot3 Plus; Olympus, Tokyo, Japan), followed by insertion of a 0.035-mm guidewire (Visiglide; Olympus), dilation of the track with a 6-mm balloon (Hurricane RX; Boston Scientific, Marlborough, Massachusetts, USA), and insertion of a partially covered SEMS, 10 cm in length, in a stent-in-stent fashion (Hanarostent, BPD-10-100; M.I. Tech) ([Fig. 3–5], [Video 1]). The postprocedural course was uneventful, clinical symptoms subsided, and bilirubin level dropped from 8.5 mg/dl to 3.1 mg/dl within 14 days allowing chemotherapy to resume. CT and endoscopy at 6 weeks confirmed the correct position of the salvage stent.
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Video 1 Successful endoscopic ultrasound-guided stent-in-stent placement for salvage management of migrated hepaticogastrostomy stent.
Qualität:
Endoscopy_UCTN_Code_CPL_1AK_2AJ
Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
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Competing interests
M. Polkowski has had consultancy and speaker agreements with Boston Scientific and Olympus. M. F. Kaminski has had speaker agreements with Olympus, Fujifilm, Medtronic, and Boston Scientific, consultancy agreements with Olympus and AlfaSigma, and received research support from Fujifilm.
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References
- 1 Hedjoudje A, Sportes A, Grabar S. et al. Outcomes of endoscopic ultrasound-guided biliary drainage: a systematic review and meta-analysis. United European Gastroenterol J 2019; 7: 60-68
- 2 De Moura DT, Mestieri LH, Cheng S. et al. Natural orifice transluminal endoscopic surgery to salvage a migrated stent during EUS-guided hepaticogastrostomy. Gastrointest Endosc 2016; 83: 656-657
- 3 Pham KD, Hoem D, Horn A. et al. Salvage of a dislodged hepaticogastrostomy stent in the peritoneum with NOTES. Endoscopy 2017; 49: 919-920
- 4 van Geenen EJM, Siersema PD. Stent migration into the abdominal cavity after EUS-guided hepaticogastrostomy. Gastrointest Endosc 2018; 87: 617-618
- 5 Cruceru M, Milashka M, Rostain F. et al. Salvage endoscopic ultrasound-guided stent placement into a stent that had migrated into the peritoneum during a hepaticogastrostomy procedure. Endoscopy 2021; 53: E69-E70
Corresponding author
Publikationsverlauf
Artikel online veröffentlicht:
01. Oktober 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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References
- 1 Hedjoudje A, Sportes A, Grabar S. et al. Outcomes of endoscopic ultrasound-guided biliary drainage: a systematic review and meta-analysis. United European Gastroenterol J 2019; 7: 60-68
- 2 De Moura DT, Mestieri LH, Cheng S. et al. Natural orifice transluminal endoscopic surgery to salvage a migrated stent during EUS-guided hepaticogastrostomy. Gastrointest Endosc 2016; 83: 656-657
- 3 Pham KD, Hoem D, Horn A. et al. Salvage of a dislodged hepaticogastrostomy stent in the peritoneum with NOTES. Endoscopy 2017; 49: 919-920
- 4 van Geenen EJM, Siersema PD. Stent migration into the abdominal cavity after EUS-guided hepaticogastrostomy. Gastrointest Endosc 2018; 87: 617-618
- 5 Cruceru M, Milashka M, Rostain F. et al. Salvage endoscopic ultrasound-guided stent placement into a stent that had migrated into the peritoneum during a hepaticogastrostomy procedure. Endoscopy 2021; 53: E69-E70
![](https://www.thieme-connect.de/media/endoscopy/202209/thumbnails/10-1055-a-1638-8983-i2661ev1.jpg)
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![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
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