2015 Volume 57 Issue 4 Pages 1184-1190
A 63-year-old woman, with a non-resectable carcinoma of the head of the pancreas and with obstructive jaundice, was admitted to another hospital and underwent the placement of a partially covered, self-expandable metallic stent (SEMS) in the lower bile duct. Approximately 170 days after stent placement, a fully covered SEMS was inserted, using a stent-in-stent technique, for the treatment of stent occlusion. After approximately 120 days, she presented to our department with acute cholangitis. An endoscopy showed that the stent-in-stent SEMS had migrated from the duodenal papilla toward the opposite side of the duodenal lumen. Due to the poor positioning of the distal side of the SEMS, stent removal was not possible. Therefore, endoscopic sectioning of the stents using argon plasma coagulation (APC) and scissor forceps was performed. After cutting halfway around the stents, the stent-in-stent SEMS was successfully removed without any complications, and bilateral biliary plastic tube stents were inserted. After the procedure, a recurrence of stent occlusion was not noted for the rest of the patient's life. We suggest that argon plasma coagulation is a safe and effective method to transect a migrated, stent-in-stent, SEMS in the distal duodenum.
