Unconventional balloon extraction for a proximally migrated biliary self-expandable metal stent

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We present the case of a 61-year-old male with biliary anastomotic stricture following liver transplantation. The stricture was refractory to plastic multistenting and a fully covered self-expandable metal stent (Boston Scientific Wallflex 10 mm x 60 mm) was then placed for six months. An elective ERCP found that the SEMS had migrated within the common bile duct with the distal flange inside the papilla. Attempts to extract the stent using Fogarty balloon and forceps were unsuccessful due to the angled morphology of the distal bile duct and probable hyperplastic overgowth of the biliary epithelium. A second transpapillary fully covered SEMS (Boston Scientific Wallflex 10 mm x 40 mm) was placed using the stent-in-stent technique. A subsequent ERCP was performed one month later and traction with forceps managed to remove only the distal SEMS. The proximal stent was strictly adherent to the biliary epithelium probably because of the angled anatomy of the common bile duct, that prevented the overgrowth removal with the stent-in-stent technique [ 1 ] [ 2 ] [ 3 ]. A dilatation balloon (Boston Scientific CRE 12/13,5/15 mm) was firstly used to dilate the papilla, and then inflated up to 15 mm perfectly shaping within the stent and the angulated bile duct. Pulling the inflated balloon was then successful in repositioning the SEMS across the papilla, where it was subsequently removed with forceps. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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