Fracture of Self-Expandable Metal Stent during Endoscopic Removal in Benign Biliary Stricture
A 62-year-old man with benign biliary stricture due to chronic pancreatitis underwent 10-mm diameter, 60-mm lengthened covered biliary SEMS (Shim-Hanaro; MI Tech, Seoul, Korea) (). After 5 months, removal of SEMS was attempted by using forcep to grasp the extraductal portion of the distal SEMS. During the procedure, duodenal end of the stent broke (), and remnant SEMS moved proximally into the common bile duct (). Despite multiple trials were attempted to retrieve the remnant SEMS by using various grasping accessories or balloon catheter, methods failed. Endoscopic papillary balloon dilatation with maximal diameter of 12 mm diameter (CRE wire-guided dilator; Boston Scientific, Marlboro, MA, USA) was performed below the remnant SEMS to make a space between the outer surface of SEMS and the inner surface of common bile duct (). Snare was advanced through the space, then the stent was grasped and retrieved without any complication (). The shows the whole feature of removed stent with fracture.