The “zipline” technique for double-balloon enteroscopy-assisted removal of a migrated stent in a peripheral bile duct

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Article published online: 2021-07-19 E-Videos The “zipline” technique for double-balloon enteroscopy-assisted removal of a migrated stent in a peripheral bile duct Video 1 The “zipline” technique utilized to access...

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Article published online: 2021-07-19 E-Videos  The “zipline” technique for double-balloon enteroscopy-assisted removal of a migrated stent in a peripheral bile duct        Video 1 The “zipline” technique utilized to access a peripheral bile duct and remove a migrated plastic stent during double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography.  Double-balloon enteroscopy-assisted en- doscopic retrograde cholangiopancrea- tography (DBE-ERCP) facilitates manage- ment of pancreatobiliary disorders in cases with surgically altered anatomy [1– 3]. However, owing to difficulties in positioning the biliary orifice and obtain- ing a suitable angulation of the bile duct and endoscope, it can be challenging to access a peripheral bile duct during DBE- ERCP. Here we present a case where a migrated stent in the bile duct at seg- ment III (B3) was successfully removed using the previously reported technique (▶ Video 1) [4].A 61-year-old man with a history of Roux- en-Y reconstruction was referred to our institution for management of a migrated plastic stent (▶ Fig. 1). We inserted a dou- ble balloon endoscope (EI-580BT; Fuji- film, Tokyo, Japan) and removed a plastic stent placed across the anastomosis site using a snare. Following biliary cannula- tion, a 0.025-inch guidewire was passed into B3. While we were attempting to grasp the migrated stent using a wire- guided basket catheter after balloon dila- tion of the anastomosis site, the stent migrated further into the peripheral por- tion of B3. Therefore, we added a looped nylon thread to one cup of the forceps (Radial Jaw 4 pediatric; Boston Scientific, Natick, Massachusetts, USA) and inserted the forceps with the loop over the prepo- sitioned guidewire (▶Fig.2). The stent was readily grasped and withdrawn to the jejunum. We then withdrew the stent through the endoscope using the snare. Radial Jaw has been one of the most popular series of biopsy forceps and has hole(s) at each cup that enable the at-tachment of a looped thread. Wire-guid- ed biopsy forceps are not available for DBE-ERCP owing to the limited length of the shaft [5]. The “zipline” technique during DBE-ERCP may facilitate target biopsy of the peripheral bile duct as well as stent removal.Endoscopy_UCTN_Code_TTT_1AR_2AZCompeting interestsDr. Nakai declares research funding from Bos- ton Scientific Japan, Century Medical, Fuji- film, Gadelius Medical, Hitachi Medical, Kaneka, and Medico’s Hirata. This work was not supported by any of those companies. The other authors declare no conflicts of in- terest related to this article.    ▶Fig.1 Computedtomographydelineat- ing a migrated stent in B3 (arrows) of a patient with a history of Roux-en-Y recon- struction. The patient underwent extend- ed right hepatectomy with hepaticojeju- nostomy for intraductal papillary neo- plasm of the bile duct. Proximal migration of a stent for the hepaticojejunostomy anastomosis site caused cholangitis, and a plastic stent was placed across the anas- tomosis site in a previous hospital.  Hamada Tsuyoshi et al. The “zipline” technique ... Endoscopy 2022; 54: E353–E354 | © 2021. Thieme. All rights reserved.E353This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
E-Videos ▶Fig.2 The“zipline”techniqueutilizedtoremoveamigratedstentinB3.aBiopsyforcepswithaloopednylonthreadpassedthroughtheholes of one cup, which allows the forceps to be advanced over a guidewire. b Double- balloon enteroscopy-assisted cholangiogram delineating a migrated stent in B3. c The stent grasped via the zipline technique. We successfully passed the threaded forceps into B3. We readily grasped and removed the migrated stent. The authorsReferences[1] Sato T, Kogure H, Nakai Y et al. A prospective study of fully covered metal stents for dif- ferent types of refractory benign biliary strictures. Endoscopy 2020; 52: 368–376[2] Anvari S, Lee Y, Patro N et al. Double-balloon enteroscopy for diagnostic and therapeutic ERCP in patients with surgically altered gas- trointestinal anatomy: a systematic review and meta-analysis. Surg Endosc 2021; 35: 18–36[3] YamadaA,KogureH,NakaiYetal.Perform- ance of a new short-type double-balloon endoscope with advanced force transmission and adaptive bending for pancreaticobiliary intervention in patients with surgically altered anatomy: a propensity-matched analysis. Dig Endosc 2019; 31: 86–93[4] Hamada T, Takahara N, Nakai Y et al. The “zipline” technique for endoscopic trans- papillary biliary biopsy. Endoscopy 2020; 52: 236–237[5] Ogura T, Okuda A, Nishioka N et al. Trans- luminal antegrade biopsy using a novel for- ceps biopsy device for hepaticojejunostomy stricture. Endoscopy 2020. doi:10.1055/a- 1260-2982 Online ahead of printBibliographyEndoscopy 2022; 54: E353–E354 DOI 10.1055/a-1530-4969ISSN 0013-726Xpublished online 19.7.2021© 2021. Thieme. All rights reserved.Georg Thieme Verlag KG, Rüdigerstraße 14, 70469 Stuttgart, Germany Tsuyoshi Hamada1 , Hirofumi Kogure1 , Ryunosuke Hakuta1, 2, Yousuke Nakai1, 2 Kazuhiko Koike11 Department of Gastroenterology, GraduateSchool of Medicine, The University of Tokyo,Tokyo, Japan2 Department of Endoscopy and EndoscopicSurgery, The University of Tokyo Hospital, Tokyo, JapanCorresponding authorYousuke Nakai, MDDepartment of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo City, Tokyo 113-8655, JapanFax: +81-3-5800-9801 [email protected] , ENDOSCOPY E-VIDEOS https://eref.thieme.de/e-videosEndoscopy E-Videos is anopen access online section, reporting on interesting casesand new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available.This section has its own submissionwebsite at https://mc.manuscriptcentral.com/e-videos E354Hamada Tsuyoshi et al. The “zipline” technique ... Endoscopy 2022; 54: E353–E354 | © 2021. Thieme. All rights reserved.This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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