title: Displacement of occluded plastic endoprostheses into the duodenum during percutaneous biliary drainage: description of an under-reported technique.
abstract: OBJECTIVE
  Percutaneous transhepatic biliary drainage (PTBD) is occasionally requested in patients with an occluded plastic stent in situ. We describe a technique for dislodging the stent into the duodenum during PTBD.
  
  
  METHODS
  Twelve patients (M:F, 9:3 mean age 70 years) with plastic stents in the common bile duct (CBD) underwent PTBD. Eleven patients had malignant obstruction and one patient had Mirizzi's syndrome and a large duodenal diverticulum. PTBD was performed using right lobe access in nine patients and a left hepatic access in three patients. The level of biliary obstruction was at the lower CBD in five patients, mid-CBD in four patients and upper CBD in three patients. After standard percutaneous biliary access was established, an 8mm by 4 cm balloon catheter was gently inflated alongside the upper end of the plastic stent and advanced over a stiff guidewire, towards the duodenum, to dislodge the plastic stent.
  
  
  RESULTS
  Plastic stents were successfully dislodged in all 11 patients with malignancy and metallic stents were deployed for palliation. In nine of 11 patients with malignant lesions the PTBD dislodgement of the plastic stent and insertion of a metallic stent was carried out as a single-step procedure. In two patients with biliary sepsis, a two-step procedure was necessary. In the patient with Mirizzi's syndrome the plastic stent could not be dislodged. No complications were observed.
  
  
  CONCLUSIONS
  Plastic stents, inserted at ERCP, can be dislodged in the majority of cases at PTBD using a balloon catheter inserted alongside the failed stent without complication.
authors.affiliation: Radiology Department, Royal London Hospital, Whitechapel, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Fotheringham
authors.forename: S
authors.initials: S
authors.lastname: Abbass
authors.forename: J C
authors.initials: JC
authors.lastname: Varghese
authors.forename: P
authors.initials: P
authors.lastname: Haslam
authors.forename: S
authors.initials: S
authors.lastname: Lyon
authors.forename: M J
authors.initials: MJ
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D020878:Device Removal / Q000379:methods*; D004322:Drainage / Q000295:instrumentation* / Q000379:methods; D004386:Duodenum; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D015607:Stents