Endoscopic retrieval of a proximally migrated biliary stent within the gallbladder lumen.

grated biliary endoprostheses include stent cannulation and subsequent bal− loon retrieval, balloon placement parallel to the stent with traction retrieval, and the use of a wire basket, snare, Soehendra stent retriever, or rat−tooth forceps [1 ± 3]. The technique chosen depends on the ex− tent of proximal stent migration, the presence of ductal dilatation or biliary stricture, and the endoscopist’s experi− ence. This report describes the retrieval of a proximally migrated biliary stent lo− cated within the gallbladder lumen. A 40−year−old woman with primary scle− rosing cholangitis underwent stent place− ment during a procedure to evaluate a dominant stricture. She subsequently presented with cholangitis, and the pre− viously placed 7−Fr double−pigtail biliary stent was found to have migrated proxi− mally into the gallbladder. She was refer− red to our center after a failed stent re− trieval procedure, when a second straight stent was placed in order to provide drainage (l" Fig. 1). After the straight stent was removed, a 0.035−inch guide wire was fed through the cystic duct and coiled within the gall− bladder (l" Fig. 2). A medium−sized snare was then placed over the guide wire into the gallbladder, and this allowed capture and eventual retrieval of the stent under fluoroscopic guidance (l" Fig. 3 ± 5). Sub− sequent cholangiography once again showed a dominant common bile duct stricture. After brush cytology and intra− ductal biopsies were obtained, a 10−Fr, 9− cm straight stent was then placed within the right intrahepatic system without fur− ther complications (l" Fig. 6). In this report we have described a meth− od for retrieving stents that have migrat− ed into the gallbladder, a problem that could could become more common in fu− ture, given the growing tendency to use stents to manage gallbladder disease [4, 5]. Notably, the endoscopist must be careful to avoid cystic duct injury during access attempts during planned stent placement procedures.