Role of cholangioscopy as a rescue technique in the retrieval of proximally migrated biliary stents COMMENTARY

A 15-years-old boy with a medical history of an orthotopic liver transplant in 2021 due to methylmalonic aciduria, on a multi-stenting strategy for biliary anastomotic strictures, underwent a reassessment endoscopic retrograde cholangiopancreatography and the two previously placed biliary stents had migrated proximally, above the anastomosis. A digital single-operator cholangioscopy was performed (SpyGlass, Boston Scientific, Marlborough, Massachusetts) with direct visualization of the migrated stents, however, the accessories through the cholangiocope, such as the SpyBite forceps or the SpySnare (Boston Scientific), were not available in our department at that time. Nevertheless, the cholangioscopy allowed a successful guidewire advancement into the lumen of the stents and its subsequent removal to the duodenum using a Soehendra Stent Retriever (Cook Japan, Tokyo, Japan). Endoscopic removal of proximally migrated stents can be challenging and cholangioscopy has emerged as an additional tool in these cases. This case report represents a successful retrieval of two biliary stents guided by cholangioscopy, avoiding further invasive procedures or even surgery with significant morbidity and mortality.