Follow-up computed tomography can prevent stent migration after endoscopic ultrasound-guided hepaticogastrostomy

Abstract

A 61-year-old man with obstructive jaundice caused by distal bile duct cancer recurrence was admitted to our hospital. As treatment, we performed endoscopic ultrasound-guided hepaticogastrostomy and placed a self-expanding metal stent. Computed tomography was performed immediately after the procedure to ensure proper stent placement. Although repeat imaging the next day revealed that the stent on the hepaticogastrostomy route had shortened, the stent on the gastric side maintained sufficient length. However, 11 days after the procedure, the stomach-to-liver distance had increased, and the stent on the gastric side was significantly shortened. Endoscopic imaging revealed that the stent had almost migrated, and we added a fully covered self-expanding metal stent into the previous metallic stent via the hepaticogastrostomy route. The patient was discharged 19 days after the initial procedure without complications. Computed tomography performed 40 days after the hepaticogastrostomy revealed that the initial stent had migrated into the abdominal cavity, but the second stent was in an appropriate position. In conclusion, repeated monitoring by computed tomography after hepaticogastrostomy procedure may be an effective method for preventing stent migration in high-risk cases.

Keywords

• adverse effects
• bile duct neoplasms
• endosonography
• jaundice
• tomography, x-ray computed