LAUSR

THE FREQUENCY OF migration of stents into bile duct has been reported to be 1.7–10%. Okabe et al. reported that some devices were effective to remove a migrated stent. However, it has been unknown that the frequency of migration of stents in patients with surgically altered anatomy. Endoscopic removal of a migrated biliary stent (BS) is technically challenging, particularly in patients with surgically altered anatomy. We report here the first successful retrieval of a migrated BS by using biliary balloon dilation catheter (Video S1). A 71-year-old woman who suspected hilar cholangiocarcinoma underwent extended left hepatectomy, choledochectomy and Roux-en Y reconstruction. Surgeons placed a plastic BS intraoperatively to choledochojejunal anastomosis. One month later, the patient was admitted to our hospital for repeated acute cholangitis. Computed tomography and abdominal ultrasonography showed intrahepatic migration of the BS without biliary dilatation (Fig. 1A,B). We attempted a short-type double-balloon endoscope (EI-580BT; FUJIFILM CO., Tokyo, Japan)assisted endoscopic retrograde cholangiography. Insertion to the blind end and discovery of choledochojejunal anastomosis were successful; however, endoscopic imaging showed severe stenosis of the choledochojejunal anastomosis (Fig. 1C). After biliary cannulation, the anastomotic site was dilated by using 6-mm biliary balloon dilation catheter (REN; Kaneka, Osaka, Japan) to access the bile