A successful biliary stent removal after trimming the duodenal metallic stent using argon plasma coagulation

Abstract

An 81-year-old male patient was diagnosed with carcinoma of the ampulla of Vater. At a previous hospital, he had undergone placement of a metallic stent in both the bile duct and duodenum in a side-to-end positional relationship for stenosis of the lower bile duct and duodenum. However, he visited our hospital because he repeatedly developed cholangitis caused by multiple bile duct stones. We planned endoscopic ultrasound-guided biliary drainage (EUS-BD) with an approach from the first part of the duodenum. First, we used argon plasma coagulation to trim the duodenal metallic stent. Next, using forceps to grip the end of the biliary stent exposed by the trimming, we removed the biliary metallic stent, which was impeding punctures. This ingenuity enabled us to succeed in EUS-BD.