Examination of removal method in inside stent based on the experience of 2 difficult cases

Abstract

The inside stent, which is stent placement above the Vater papilla, has been invented to retain the function of the sphincter of Oddi. It is expected to extend the patency period compared with the normal biliary plastic stent. To remove the stent, the attached nylon thread must be pulled and exposed to the duodenal lumen, which may cause an accidental event if it is not removed properly. We examined the causes that had difficulty in removing the inside stent. In case 1, we grasped the nylon thread with a biopsy forceps but slipped, therefore, we inserted a biopsy forceps into the bile duct and grasped the inside stent directly. Because the removal procedure did not along the biliary axis, the inside stent was bent and got caught on Vater papilla. After EST, the bent stent was removed from papilla. In case 2, the nylon thread was slipped as in case 1. We changed the biopsy forceps and removed the inside stent. We suggested that the inside stent must be removed carefully along the biliary axis.