An 84-year-old woman with history of carcinoma of the papilla of Vater, in which percutaneous transhepatic stent was placed, was admitted to our hospital with a complaint of fever. The patient was diagnosed as cholangitis.
Immediate endoscopy examination revealed that the stent was projecting long and distal side of the stent had been embedded into the duodenal wall which located opposite to the papilla of Vater. Because of tumor in-growth, removal of the stent was impossible. In the literature, as well-known, endoscopic section of migrated stent using argon plasma coagulation (APC) is useful. However, the risk of the duodenal mucosa injury was the matter because the stent was embedded. We removed the distal side stent which is embedded to the duodenal wall using biopsy forceps without any complication.
Afterwards we put covered stent into the original metallic stent with stent-in-stent manner. We conclude that biopsy forceps is safe and useful to dissect an embedded uncovered biliary stent.
