• Users Online:1182
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

Ahead of print publication  

Spy basket retrieval method of an embedded hepaticogastrostomy stent (with videos)

1 Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center; Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
2 Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
3 Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Date of Submission26-Sep-2021
Date of Acceptance14-Feb-2022
Date of Web Publication20-Jul-2022

Correspondence Address:
Toyoma Kaku,
Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-21-00213

PMID: 35899901

How to cite this URL:
Ohno A, Kaku T, Fujimori N. Spy basket retrieval method of an embedded hepaticogastrostomy stent (with videos). Endosc Ultrasound [Epub ahead of print] [cited 2022 Dec 1]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=351307

EUS-guided hepaticogastrostomy (EUS-HGS) is performed for benign biliary diseases as an alternative therapy for ERCP. However, a critical adverse event such as stent migration was reported.[1] Recently, stent retrieval method in the HGS route using Spy bite (Boston Scientific, Marlborough, Massachusetts, USA),[2] forceps,[3] or balloon[4] has been reported. We report a case that the plastic stent (PS) retrieval method using Spy basket (Boston Scientific) [Figure 1] and grasping the flap of PS was efficient as a new stent retrieval method.
Figure 1: Spy basket (Boston Scientific, Marlborough, Massachusetts, USA)

Click here to view

A 70-year-old man with a history of pancreaticoduodenectomy was admitted to our institution to treat intrahepatic biliary stones. Because we failed to remove stones under enteroscope-assisted ERCP due to the instability of the scope, we decided to perform EUS-HGS. At first, a PS was placed in the choledochojejunostomy route, and a metallic stent was placed across the HGS route due to the incomplete stone extraction because of large stone size [Video 1 [Additional file 1]]. One month later, the PS was revealed to be placed into B2 [Figure 2]a. It seemed to be difficult to retrieve the PS because of embedding into not B3 but B2. After we removed the metallic stent in the HGS route, cholangioscope (Spy-Glass DS; Boston Scientific) was inserted. Although we failed to catch the PS by Spy bite under direct visualization [Video 2 [Additional file 2]], we could successfully grasp the flap of embedded stent and easily retrieve it using a Spy basket [[Figure 2]b, [Figure 2]c and Video 3 [Additional file 3]]. Finally, stones were completely extracted using electrohydraulic lithotripsy with a cholangioscopy. No procedure-related adverse events occurred [Figure 2]d. Although stent dislocation can be a serious complication during interventional EUS and may need surgical intervention, cholangioscopy-guided grasping the flap of PS by Spy basket can be an effective method for retrieval of embedded PS.
Figure 2: Retrieval of an embedded stent using a digital cholangioscopy and Spy basket; (a) An embedded plastic stent to the left lateral branch of the bile duct (B2). (b and c) The embedded stent was grasped using a Spy basket under digital cholangioscopic visualization, on the cholangioscopic image and fluoroscopic image. (d) Fluoroscopic image of the biliary duct after removal of the stent and intrahepatic biliary stones

Click here to view

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ogura T, Higuchi K. Endoscopic ultrasound-guided hepaticogastrostomy: Technical review and tips to prevent adverse events. Gut Liver 2021;15:196-205.  Back to cited text no. 1
Tanaka R, Mukai S, Itoi T, et al. New digital cholangioscopy-guided removal of a transpapillary plastic stent through the hepaticogastrostomy route. Gastrointest Endosc 2016;84:371.  Back to cited text no. 2
Miwa H, Sugimori K, Ozeki Y, et al. Biliary stent removal through a transgastric fistula created with endoscopic ultrasound-guided hepaticogastrostomy. Clin J Gastroenterol 2021;14:304-8.  Back to cited text no. 3
Ogura T, Ueno S, Nishioka N, et al. Fine-gauge balloon-assisted stent removal technique for ruptured EUS-guided hepaticojejunostomy plastic stents (with video). Endosc Ultrasound 2020;9:143-5.  Back to cited text no. 4


  [Figure 1], [Figure 2]


     Search Pubmed for
    -  Ohno A
    -  Kaku T
    -  Fujimori N
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
   Article Figures

 Article Access Statistics
    PDF Downloaded16    

Recommend this journal