P1765 - A Novel Technique for the Removal of a Migrated Duodenal Stent to Descending Colon

William D. Davis, DO¹, Christine Hill, BS², Ahmed Al Nakshabandi, MD¹, Joseph J. Jennings, MD^3
1MedStar Georgetown University Hospital, Washington, DC; ²Georgetown University, Washington, DC; ³Georgetown University Hospital, Washington, DC

Introduction: Duodenal stents are often used for palliation in malignant gastroduodenal obstruction. However, stent related complications occur in up to 17% of cases, with perforation and stent migration seen in up to 5%. This case features a novel technique for retrieving a pyloric sphincter-proximal duodenum stent that migrated to the descending colon.

Case Description/Methods: A 58-year-old male with history of stage IV metastatic gastric cancer on pembrolizumab presented 4 months after placement of a duodenal uncovered self-expanding metal stent (UCSEMS) [22x 120mm] to known pyloric and duodenal strictures with 5 days of intermittent, sharp, post-prandial left lower quadrant abdominal pain.

Computed tomography and colonoscopy confirmed migration of the UCSEMS with embedment into the mucosa and associated erythema, edema, and ulceration. The stent was not retrieved, and the patient was transferred to a tertiary care center. Biopsies of this edematous region demonstrated poorly differentiated adenocarcinoma.

At the tertiary care center, 10 days after initial colonoscopy, repeat imaging confirmed no perforation of the embedded stent. The patient then underwent flexible sigmoidoscopy. The UCSEMS was located in the descending colon, embedded into an edematous fold with surrounding ulceration, granulation tissue and spontaneous bleeding. A single rat tooth forceps was used to dislodge the stent proximally. Though the stent was patent, the forceps could not traverse the edematous fold distally.

A therapeutic dual channel endoscope (Pentax) with rat tooth forceps in each channel was then used to grasp the distal ends of the stent at contralateral sides. Forceps were then retracted toward the enteroscope, approximating the distal ends of stent. By decreasing the diameter of the distal end of the stent, it was possible to navigate the stent over the raised area of prior embedment. The stent was then easily retracted through the remaining colon. Re-insertion of the scope showed friable, bleeding tissue at the embedment site with no signs of perforation.

Discussion: Though the invagination technique was attempted, the stent was unable to pass through itself and traverse the edematous mucosa. This novel method for removing an UCSEMs can thus be implemented with severe impediment to distal translocation of stent.


Disclosures:
William Davis indicated no relevant financial relationships.
Christine Hill indicated no relevant financial relationships.
Ahmed Al Nakshabandi indicated no relevant financial relationships.
Joseph Jennings indicated no relevant financial relationships.


William D. Davis, DO¹, Christine Hill, BS², Ahmed Al Nakshabandi, MD¹, Joseph J. Jennings, MD³. P1765 - A Novel Technique for the Removal of a Migrated Duodenal Stent to Descending Colon, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.