Endoscopic Retrieval of a Proximally Migrated Biliary Stent Using Digital Cholangioscope

Manjakkollai P. Veerabagu,MD^*

*Correspondence to: Dr. Manjakkollai P. Veerabagu, MD, Affiliate Associate Professor of Medical University of South Carolina, Department of Medicine, Anderson, South Carolina.

Copyright

© 2026 Dr. Dr. Manjakkollai P. Veerabagu, MD, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 15 January 2025

Published: 01 February 2026

DOI: https://doi.org/10.5281/zenodo.18450407

Abstract

Migration of biliary stent occurs infrequently. Retrieval of migrated biliary stent can be challenging. We report a case of successful retrieval of proximally migrated biliary stent using digital cholangioscope. 

Keywords: Endoscopic retrograde Cholangiopancreatograpy, Cholangioscope, Duodenoscope, Stent

Case Reports

A 68 year old man was admitted to the hospital with worsening epigastric abdominal pain, nausea, vomiting and elevated liver enzymes. His cross sectional imaging showed 6 mm  stone in the dilated bile duct (Fig.1). No stones were seen in the gallbladder. His blood work showed leukocytosis WBC 18,590/mm3, Bilirubin was 2.9 mg/dL, ALT was 126 IU/L.  He underwent endoscopic retrograde cholangiopancreatograpy (ERCP) for removal of  common bile duct stone. At the time of the procedure sphincterotomy was performed and the stone was removed using stone extraction balloon. Temporary plastic stent was placed at that time (Fig.2) and the patient underwent successful cholecystectomy a day following this procedure. Four weeks later endoscopic retrieval of the stent was done. At that time the stent was not seen through the major ampulla (Fig 3). X ray of the abdomen confirmed the migration of the biliary stent to the right hepatic duct and the distal end was in the common hepatic duct (Fig.4) We used digital cholangioscope (SpyGlass DS II, Boston Scientific, MA, USA) and using a forceps (Spybite, Boston Scientific, MA, USA) through the cholangioscope the stent was successfully removed (Fig 5-7).

Migration of biliary stent rate is 5 to 10% of patients and plastic biliary stent in particular occurs in 13.5% of the time1. The risk factors for the migration include bile duct stricture, dilation of the bile duct and straight long stents1. Migrating stent may result in biliary obstruction and or infection. Retrieval of migrated stents are done using endoscope and rarely requires surgical intervention. Various techniques have been described in removal of migrated stents namely balloons, baskets, foreign body forceps2-4 and via cholangioscope using forceps or snare. In our patient we used forceps through the cholangioscope. This enabled direct visualization of the migrated stent and quick retrieval and the patient was discharged home the same day without any adverse event.

References

1. Kawaguchi Y, Ogawa M, Kawashima Y, Mizukami H, Maruno A, Ito H, et al. Risk factors for proximal migration of biliary tube stents. World J Gastroenterol 2014;20:1318-24. Doi:10.3748wjg.v20.i5.1318.

2. Chaurasia OP, Rauws EA, Fockens P, Huibregtse K,.Endoscopic techniques for retrieval of proximally migrated biliary stents: the Amsterdam experience. Gastrointest Endosc 199;50:780-5, doi:10.1016/s0016-5107(99)70158-6.

3. Katsinelos P, Kountouras J, Paroutoglou G, et al. Migration of plastic biliary stents and endoscopic retrieval: An experience of three referral centers. Surg laparosc Endosc Percutn Tech. 2009;19(3):217-21.

4. Mahros AM, Elfert AA, Maksoud HA, Elkerdawy M, Fahmy MM, Ahmed MH. Dormia basket versus extraction balloon in proximally migrated biliary stents. J Pak Med Assoc. 2023;73 (Suppl 4):S39-42.