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Retrieval of a migrated stent during endoscopic ultrasound-guided drainage of duodenal diverticular abscess.

Endoscopic ultrasound (EUS)-guided drainage for an abdominal abscess has become recognized as a minimally invasive alternative to surgery. With regard to EUS-guided drainage of a pancreatic pseudocyst, the occurrence of stent migration into the pseudocyst is a relatively rare complication [1] and can be prevented by using double-pigtail stents [2]. This report describes endoscopic retrieval of a migrated double-pigtail stent during EUS-guided drainage of duodenal diverticular abscess. A 91-year-old woman with upper right abdominal pain and fever was referred to our hospital. Computed tomography showed a duodenal diverticular abscess (●" Fig.1). Therefore, EUS-guided drainage of the abscess was performed. The abscess was punctured with a 19-gauge needle, and a 0.025-inch guidewire was placed. Subsequently, an additional guidewire was placed using a triple-lumen catheter (Haber RAMP catheter; Cook Japan, Tokyo, Japan) (●" Fig.2a). A 7-Fr double-pigtail stent was placed over the wire. However, before the nasobiliary drainage tube could be placed, the stent accidentally jumped into the abscess (●" Fig.2b). We opted to retrieve the migrated stent using a basket catheter. First, the triplelumen catheter was inserted over the remaining guidewire to place an additional guidewire. Then, a basket catheter (FG-V435P; Olympus Medical Systems Corp., Tokyo, Japan) was introduced into the abscess over the guidewire, and the migrated stent was removed by grasping its tip with the basket catheter (●" Fig.2c, ●" Video1). Finally, a 7-Fr double-pigtail stent and a 7-Fr nasobiliary drainage tube were placed successfully (●" Fig.2d). The endoscopic retrieval of a migrated stent is technically challenging. In a few cases of pancreatic pseudocyst, migrated stents have been removed by forceps using a forward-viewing endoscope [3– 5]. In our patient, the migrated stent was successfully retrieved by EUS scope using a basket catheter under fluoroscopy. Furthermore, it is important to place an additional guidewire during the procedure in case a guidewire slips out.