|IMAGES AND VIDEOS
|Ahead of print publication
Spy basket retrieval method of an embedded hepaticogastrostomy stent (with videos)
Akihisa Ohno1, Toyoma Kaku2, Nao Fujimori3
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 Submission||26-Sep-2021|
|Date of Acceptance||14-Feb-2022|
|Date of Web Publication||20-Jul-2022|
Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563
Source of Support: None, Conflict of Interest: None
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. Recently, stent retrieval method in the HGS route using Spy bite (Boston Scientific, Marlborough, Massachusetts, USA), forceps, or balloon 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)|
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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|
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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.
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[Figure 1], [Figure 2]