title: Endoscopic removal of a spontaneously fractured biliary uncovered self-expandable metal stent.
abstract: Self-expandable metal stents (SEMS) are widely used for the palliative treatment of unresectable malignant biliary obstruction. However, the long-term durability of SEMSs in biliary strictures is not clear. We describe a case of endoscopic removal of spontaneously fractured uncovered biliary SEMS. A 59-year-old woman presented to our institution with a 1-year history of recurrent cholangitis. Her medical history included a proctectomy for rectal cancer and right hemihepatectomy for liver metastasis 10 years earlier. Five years after these operations, she developed a benign hilar stricture and had an uncovered SEMS placed in another hospital. Endoscopic retrograde cholangiopancreatography demonstrated that the SEMS was torn in half and the distal part of the stent was floating in the dilated common bile duct. The papillary orifice was dilated by endoscopic papillary large balloon dilation (EPLBD) using a 15-mm wire-guided balloon catheter. Subsequently, we inserted biopsy forceps into the bile duct and grasped the distal end of the broken SEMS under fluoroscopy. We successfully removed the fragment of the SEMS from the bile duct, along with the endoscope. The patient was discharged without complications. Placement of an uncovered biliary SEMS is not the preferred treatment for benign biliary strictures. Spontaneous fracture of an uncovered biliary SEMS is an extremely rare complication. We should be aware that stent fracture can occur when placing uncovered biliary SEMSs in patients with a long life expectancy. EPLBD is very useful for retrieving the fractured fragment of SEMS.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Kawakubo
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Naoki
authors.initials: N
authors.lastname: Sasahira
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hamada
authors.forename: Rie
authors.initials: R
authors.lastname: Nagano
authors.forename: Kouji
authors.initials: K
authors.lastname: Miyabayashi
authors.forename: Keisuke
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Dai
authors.initials: D
authors.lastname: Mohri
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Ito
authors.forename: Natsuyo
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D001661:Biliary Tract Neoplasms / Q000601:surgery*; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000175:diagnosis / Q000601:surgery*; D003251:Constriction, Pathologic; D020878:Device Removal; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008875:Middle Aged; D011475:Prosthesis Failure; D011860:Radiography, Abdominal; D015607:Stents