nowadays , insertion of an expandable metallic stent ( ems ) is the standard treatment to rescue obstructive jaundice caused by unresectable pancreaticobiliary malignancies . as one of the problematic complications of biliary ems , stent migration occurs in 1.8 - 8.3% of cases with covered biliary ems and in 0 - 2.4% of uncovered ems . migration of biliary ems may cause severe complications such as ulceration , perforation   and intestinal obstruction , so that appropriate treatments are needed . several techniques have been reported on endoscopic removal of biliary ems   and the success rate of removal was 86.4 - 92.3%   in cases of covered ems . however , it is still difficult in cases of uncovered ems ( 0 - 38.4% ) . stent trimming is another approach to treat ems migration . to date , yag laser   and argon plasma   have been applied to transect metallic stents . we herein report a case of advanced pancreatic cancer with occurrence of obstructive jaundice due to migration and occlusion of a self - expandable biliary nitinol stent . in april 2007 , an 84-year - old man developed jaundice and was admitted to hospital . by several image examinations and blood test he refused aggressive therapies such as surgical operation and chemotherapy because of insufficient physical condition and high age . to rescue obstructive jaundice , after temporary nasobiliary drainage , an uncovered ems ( niti - s biliary stent , 10 mm  6 cm ) was inserted in the lower bile duct in june 2007 . during best supportive care , he developed icterus and was referred to our institute in july 2008 . on admission , laboratory data showed bilirubinemia ( total bilirubin : 3.0 mg / dl ) , a high level of hepatobiliary enzyme ( got : 129 u / l , gpt : 78 u / l , gtp : 574 u / l ) and inflammatory reaction ( crp : 3.11 mg / dl ) . a duodenoscope ( olympus , jf-260v ) was inserted to examine biliary obstruction . at the duodenal papilla , the biliary ems was migrated toward the anal side of the duodenal lumen about 2 cm in length ( fig . the stent was not covered and it seemed difficult to remove by grasping or snaring stent   despite a couple of attempts . the endoscope was changed into the upper gastrointestinal scope ( olympus , gf - h260 ) with hood attachment at the top and was inserted again . trimming of the ems was performed using argon plasma , a few millimeters from the papilla 's orifice , in order not to cause ulceration or oozing from the duodenal mucosa ( fig . air vacuuming was frequently done to reduce inspired gas in the duodenum . in about 30 min , the ems was completely cut off and the distal side of the stent was removed . by mechanical cleaning using balloon catheter ( olympus , multi3v , 15 mm ) ( fig . four months after this procedure , the patient succumbed to severe pneumonia , but no recurrence of jaundice was noted after the procedure of ems trimming . the incidence of biliary ems migration is not really high ( 0 - 8.3% ) and it is less frequent in cases of uncovered ems . endoscopic removal is successful in most cases of covered ems ( success rate : 86.4%   to 92.3% ) , but it is difficult in uncovered ones ( 0%   to 38.4% ) . several methods have been developed to efficiently improve the removal of ems without complication , such as the  lasso technique , the  wire - loop technique , or the  open - biopsy - forceps technique   using foreign - body forceps and polypectomy snares . described that removal of uncovered ems was difficult and required a combination of techniques in addition to the devices previously described . however , when the inserted ems was migrated , most patients with pancreaticobiliary malignancies were thought to be in advanced stage , hence a less invasive approach is needed for the management of biliary drainage . recently , demarquay et al . demonstrated the efficacy of argon plasma for endoscopic shortening of biliary wallstent   and they also succeeded in trimming other types of ems , including esophageal and colorectal stents . according to the report mostly done on wallstent with largest the series ( 31 cases ) , recommended power setting was 70 - 80 w with argon flow of 0.8 l / min , however it was quite similar to ours according to the second largest study ( 6 cases ) done on nitinol stent ( 60 w , 1.8 l / min ) . by an in vitro experimental model , it is reported that at least 60 w of argon plasma was required to cut the bare metallic stent , with a different effect level by duration of irradiation and stent condition ( wet or dry ) . we should be careful on the type of stent metal , because melting temperature is different between nitinol alloy ( niti - s stent ) and stainless steel ( wallstent ) . as the temperature generated by argon plasma is between 1,000 and 1,300c and the melting point of nitinol ( alloy of nickel and titanium ) is around 1,200 - 1300c , nitinol stents can be easily cut . while trimming ems , we must be aware that the stent is well washed out and there is no sludge on the surface so that heat energy conducts well . transection of the biliary metallic stent was performed with argon plasma in acceptable time without complication . today we suggest that argon plasma trimming is a less expensive , safe and effective method to rescue migrated uncovered biliary metallic stents .