Tarnasky P R, Cotton P B, Baillie J, Branch M S, Affronti J, Jowell P, Guarisco S, England R E, Leung J W
Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Gastrointest Endosc. 1995 Dec;42(6):513-20. doi: 10.1016/s0016-5107(95)70003-x.
Proximal migration of a biliary stent is an uncommon event, but its management can present a technical challenge to the therapeutic endoscopist.
We reviewed the methods that have been used for retrieval of proximally migrated biliary stents in a referral endoscopy center.
Forty-four cases were identified; 38 stents (86%) were extracted successfully. Half of the stents were retrieved after first passing a guide wire through the stent lumen. Various accessories were then used to withdraw the stents, the Soehendra device being the most popular. Nearly one third were retrieved by grasping the stents directly, usually with a wire basket or forceps. The remainder were recovered after using a stone retrieval balloon alongside the stents to provide traction indirectly. Interventional radiology techniques were needed in two cases, and surgery in one.
Cannulating the stent lumen with a wire is often the best approach in patients with a biliary stricture or a nondilated duct. An over-the-wire accessory can then be used to secure the stent. In patients with a dilated duct, indirect traction with a balloon or direct grasping of the stent with a wire basket, snare, or forceps is usually successful. Using these techniques, most proximally migrated biliary stents can be retrieved endoscopically.
胆管支架近端移位是一种罕见事件，但其处理可能给治疗内镜医师带来技术挑战。
我们回顾了在一家转诊内镜中心用于取出近端移位胆管支架的方法。
共确定44例；38枚支架（86%）成功取出。一半的支架是在首先将导丝穿过支架管腔后取出的。然后使用各种附件取出支架，其中Soehendra器械最常用。近三分之一的支架是直接通过抓持取出的，通常使用网篮或钳子。其余的是在使用结石取出球囊与支架并行以间接提供牵引力后取出的。2例需要介入放射学技术，1例需要手术。
对于胆管狭窄或胆管未扩张的患者，用导丝插入支架管腔通常是最佳方法。然后可以使用导丝引导的附件固定支架。对于胆管扩张的患者，用球囊间接牵引或用网篮、圈套器或钳子直接抓持支架通常是成功的。使用这些技术，大多数近端移位的胆管支架可以通过内镜取出。
