
==== Front
Endoscopy
Endoscopy
10.1055/s-00000012
Endoscopy
Endoscopy
0013-726X
1438-8812
Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

10.1055/a-2387-3765
E-Videos-2024-04-4990-EV
E-Videos
Successful removal of a stuck plastic stent in an echoendoscope by additional insertion of a transnasal endoscope
http://orcid.org/0000-0002-8197-5082
Namima Daisuke Dr.
http://orcid.org/0000-0001-7367-0767
Fujisawa Toshio Dr.
Takahashi Sho Dr.
Takasaki Yusuke Dr.
Tomishima Ko Dr.
Ishii Shigeto Dr.
http://orcid.org/0000-0002-6206-9236
Isayama Hiroyuki MD, PhD
1 73362 Department of Gastroenterology, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Japan
Correspondence Hiroyuki Isayama, MD, PhD Department of Gastroenterology, Graduate School of Medicine, Juntendo University2-1-1 Hongo, Bunkyo-KuTokyo 113-8421Japanh-isayama@juntendo.ac.jp
10 9 2024
12 2024
1 9 2024
56 Suppl 1 E776E777
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
2024
The Author(s).
https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
==== Body
pmc Various innovations have been reported as troubleshooting measures in response to the increasing adoption of interventional endoscopic ultrasound (EUS) 1 2 3 . We report herein a case in which a plastic stent, stuck in the working channel outlet of an echoendoscope (EG-740UT; Fujifilm, Tokyo, Japan), was successfully removed without echoendoscope withdrawal, and the guidewire was kept in place by additional insertion of a transnasal slim endoscope.

A 68-year-old man underwent EUS-guided hepaticogastrostomy (EUS-HGS) for intrahepatic bile duct stones secondary to hepaticojejunostomy stenosis (HJSS) ( Fig. 1 ). Stent exchange and additional stent insertion were performed to dilate the EUS-HGS tract and HJSS 1 month after the initial EUS-HGS. After placement of a guidewire in the bile duct beside the previously placed plastic stent using an echoendoscope, we attempted to remove the plastic stent with grasping forceps. However, the plastic stent had become stuck in two folds in the working channel outlet of the echoendoscope ( Fig. 2 ). We tried unsuccessfully to push and pull the plastic stent with the grasping forceps. Because passing the liver parenchyma had been difficult in the initial EUS-HGS, we kept the guidewire in place because reinserting it would be difficult if it were once withdrawn. We attempted to retrieve the stuck plastic stent by additionally inserting a slim transnasal endoscope (GIF-XP290N; Olympus, Tokyo, Japan) while maintaining the orally inserted echoendoscope. First, the portion of the plastic stent protruding outside the echoendoscope was grasped with a small-caliber snare ( Fig. 3 ). Next, the plastic stent was successfully removed by pulling out the slim transnasal endoscope. The guidewire was kept in the bile duct, and subsequent procedures were smoothly performed. Finally, we successfully placed two plastic stents in the EUS-HGS tract, bridging the HJSS ( Video 1 ).

Fig. 1 Initial endoscopic ultrasound-guided biliary duct drainage in a 68-year-old man. a Contrast injection revealed intrahepatic bile duct stones (arrowheads) secondary to hepaticojejunostomy stenosis. b A 7-Fr plastic stent was placed to connect the jejunum, bile duct, and stomach.

Fig. 2 During stent exchange and additional stent insertion 1 month later, to dilate the EUS-HGS tract and HJSS, the previously placed plastic stent became stuck in two folds in the working channel outlet of the echoendoscope (arrow).

Fig. 3 The portion of the plastic stent protruding outside the echoendoscope was grasped with a small-caliber snare.

Successful removal of a stuck plastic stent in an echoendoscope by additional insertion of a transnasal endoscope. GW, guidewire; PS, plastic stent.

Video 1

The simultaneous use of two endoscopes has been reported in various endoscopic procedures and is considered a valuable troubleshooting option 4 5 .

Endoscopy_UCTN_Code_CPL_1AL_2AD

Endoscopy E-Videos https://eref.thieme.de/e-videos

E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos .

Conflict of Interest H. Isayama was supported by research grants from Boston Scientific Japan and FujiFilm Corporation. The funding source has no role in the design, practice, or analysis of this study. D. Namima, T. Fujisawa, S. Takahashi, Y. Takasaki, K. Tomishima, and S. Ishii declare that they have no conflicts of interest to disclose.
==== Refs
References

1 Ogura T Higuchi K Endoscopic Ultrasound-guided hepaticogastrostomy: technical review and tips to prevent adverse events Gut Liver 2021 15 196 205 10.5009/gnl20096 32694240
2 Matsubara S Nakagawa K Suda K Practical tips for safe and successful endoscopic ultrasound-guided hepaticogastrostomy: a state-of-the-art technical review J Clin Med 2022 11 1591 10.3390/jcm11061591 35329917
3 Takahashi S Ishii S Suzuki A Successful retrieval of a lumen-apposing metal stent that had completely migrated into the cavity of a walled-off necrosis Endoscopy 2023 55 885 886 37643606
4 Mahler MA Prieto RG Oria I Single-session EUS-guided hepaticogastrostomy and dual-scope gastroenterostomy: a modified technique for palliative double endoscopic biliary and gastric bypass Endoscopy 2018 50 78 79 10.1055/s-0043-119972 29041017
5 Matsumoto K Nakamatsu D Nishida T Double-scope method is helpful to rescue a retrieval thread attached to a stent caught on the duodenoscope forceps elevator Dig Endosc 2022 34 22 23 10.1111/den.14183
