Shah Dharmesh K, Jain Samit S, Somani Piyush O, Rathi Pravin M
Trop Gastroenterol. 2014 Apr-Jun;35(2):103-6. doi: 10.7869/tg.188.
Proximal migration of biliary stents presents a technical challenge for the therapeutic endoscopist. It may require multiple, complicated corrective procedures resulting in significant morbidity to the patients. In this study we evaluated the utility of balloon biliary sphincteroplasty with CRE (Controlled Radial Expansion) Balloon Dilator on retrieval of proximally migrated biliary stents.
We identified patients from our ERCP database who presented with proximal migration of biliary stent, between August 2011 and October 2013. Patients in whom the stent could not be retrieved with conventional methods, balloon sphincteroplasty was performed with a 12 mm CRETM Balloon Dilator (Boston Scientific). Stent removal was attempted with extraction balloon or basket thereafter.
We identified 28 patients with proximal migration of biliary stents, placed for benign diseases of the common bile duct. Stent removal was successful in 18 patients (64.28%) with help of an extraction balloon or basket. Of the remaining 10 patients, balloon sphincteroplasty was successfully followed by stent removal in eight patients.
Balloon biliary sphincteroplasty increases the success rate of retrieving proximally migrated biliary stents. The procedure is safe, technically easy and yields a good success rate in our experience.
胆管支架近端移位给治疗内镜医师带来了技术挑战。这可能需要多次复杂的矫正手术，给患者带来显著的发病率。在本研究中，我们评估了使用可控径向扩张（CRE）球囊扩张器进行球囊胆管括约肌切开术在取出近端移位胆管支架方面的效用。
我们从2011年8月至2013年10月期间的内镜逆行胰胆管造影（ERCP）数据库中识别出胆管支架近端移位的患者。对于那些无法用传统方法取出支架的患者，使用12毫米的CRETM球囊扩张器（波士顿科学公司）进行球囊括约肌切开术。此后尝试用取出球囊或网篮取出支架。
我们识别出28例因胆总管良性疾病放置胆管支架后近端移位的患者。在取出球囊或网篮的帮助下，18例患者（64.28%）成功取出支架。在其余10例患者中，8例在球囊括约肌切开术后成功取出支架。
球囊胆管括约肌切开术提高了取出近端移位胆管支架的成功率。根据我们的经验，该手术安全、技术上简单且成功率高。
