Volume 4, Issue 2, Pages (February 2019)

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Volume 4, Issue 2, Pages 72-75 (February 2019) Recalcitrant embedded biliary self-expanding metal stents: a novel technique for endoscopic extraction Marc Bernon, MB, ChB, FCS, Christo Kloppers, MB, ChB, FCS, Jessica Lindemann, MD, Jake E.J. Krige, MB, ChB, FCS, FACS, FRCS, PhD, Eduard Jonas, MB, ChB, MMed, FCS, PhD VideoGIE Volume 4, Issue 2, Pages 72-75 (February 2019) DOI: 10.1016/j.vgie.2018.09.016 Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 Coronal CT image from the portal venous phase, performed at admission, showing a diffusely abnormal-appearing gallbladder with wall thickening and a soft-tissue mass in the central hilar region associated with intrahepatic bile duct dilatation. VideoGIE 2019 4, 72-75DOI: (10.1016/j.vgie.2018.09.016) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 MRCP at initial presentation demonstrating a 2-cm stricture in the common hepatic duct with bilateral intrahepatic biliary dilatation. VideoGIE 2019 4, 72-75DOI: (10.1016/j.vgie.2018.09.016) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 Coronal image from 5-minute delayed-phase magnetic resonance imaging 5 weeks after presentation showing nearly complete resolution of the previously observed findings. VideoGIE 2019 4, 72-75DOI: (10.1016/j.vgie.2018.09.016) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 The distal end of the uncovered SEMS is clearly visible in the duodenum. SEMS, Self-expanding metal stent. VideoGIE 2019 4, 72-75DOI: (10.1016/j.vgie.2018.09.016) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 5 Passage of a guidewire through 2 fenestrations in the uncovered stent, catching the distal end in a loop. VideoGIE 2019 4, 72-75DOI: (10.1016/j.vgie.2018.09.016) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 6 An uncovered SEMS with the positioned guidewire and a Soehendra lithotriptor in place. SEMS, Self-expanding metal stent. VideoGIE 2019 4, 72-75DOI: (10.1016/j.vgie.2018.09.016) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 7 Distortion of distal stent due to snapping of the stent wire through which the guidewire was looped as the wire was pulled into the sheath. VideoGIE 2019 4, 72-75DOI: (10.1016/j.vgie.2018.09.016) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 8 Postprocedure cholangiogram demonstrating an intact and patent biliary tree with air in the extrahepatic bile ducts and left intrahepatic duct. VideoGIE 2019 4, 72-75DOI: (10.1016/j.vgie.2018.09.016) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 9 The right-sided stent is in place with the guidewire within the left duct for subsequent placement of the left-sided stent. VideoGIE 2019 4, 72-75DOI: (10.1016/j.vgie.2018.09.016) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions