Strategic International Session2(JGES・JSGE・JSGS)
Fri. November 3rd   9:00 - 12:00   Room 11: Portopia Hotel South Wing Topaz
ST2-6_E
 Endoscopic rescue of acute metallic stent migration during EUS guided biliary drainage
Raymond Shing-Yan Tang
The Chinese University of Hong Kong
While EUS guided hepaticogastrostomy (EUS-HGS) is a valuable alternative to percutaneous transhepatic biliary drainage (PTBD) for malignant biliary obstruction when ERCP is not feasible in patients with surgically altered anatomy or duodenal obstruction, it remains technically demanding. Despite the use of dedicated hybrid self-expandable metallic stents (SEMS), intra-procedure stent migration into the peritoneum or stomach may occur. Endoscopic rescue of migrated HGS SEMS in the same session may be feasible in selected patients which can potentially save patient from surgical rescue.
If the proximal end of the migrated HGS SEMS in the peritoneum is still close to the gastric puncture site, an alligator forceps can be used to grab the SEMS under fluoroscopic and EUS guidance for stent removal or re-establishment of biliary drainage via the gastric puncture site. If guidewire access through the migrated SEMS is still available, coaxial stent-in-stent insertion of a partially-covered SEMS can be attempted to re-establish biliary drainage via the gastric puncture site. If the above techniques fail, intraperitoneal endoscopic snare retrieval of the proximal end of the migrated SEMS by an ultrathin gastroscope via the gastric puncture site to re-establish biliary drainage route can be considered. By contrast, if the HGS SEMS migrates into stomach, re-attempt EUS-HGS in same session vs urgent PTBD in another dilated left intrahepatic duct segment should be considered to address bile leak from the original track.
Index Term 1: EUS guided hepaticogastrostomy
Index Term 2: stent migration
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