Successful cholangioscopic retrieval of a completely migrated stent in the gallbladder following endoscopic transpapillary gallbladder drainage

Endoscopic transpapillary gallbladder drainage (ETGBD) is an effective option for acute cholecystitis in patients unfit for surgery.[ 1​ ] Although rare, proximal stent migration poses significant retrieval challenges,[ 2​ ] [ ​3​ ] especially when completely migrated into the gallbladder. Cholangioscopy offers a useful solution for retrieving migrated stents that are inaccessible using conventional techniques.[ 4​ ] [ ​5​ ] We present the successful application of cholangioscopy to retrieve a completely migrated stent in a patient’s gallbladder following ETGBD. A 65-year-old man suffered acute cholecystitis. Imaging findings showed multiple gallstones. His comorbidities, including severe obesity, liver cirrhosis, and advanced hepatocellular carcinoma managed by hepatic arterial infusion chemotherapy, rendered cholecystectomy unsuitable. ETGBD was performed using a specifically designed 5-Fr plastic stent featuring a proximal spiral structure and a distal pigtail to prevent migration (IYO-stent, Gadelius Medical, Japan). However, the stent had completely migrated into the gallbladder 2 months later, causing cholecystitis recurrence ([ Fig. 1a and b ]). Attempts to retrieve the stent using a conventional transpapillary approach with forceps and a snare were unsuccessful due to difficulty grasping the stent within the expanded gallbladder lumen ([ Fig. 1c ]). A 7-Fr double pigtail stent was placed alongside the migrated stent to maintain gallbladder drainage. Nonetheless, his cholecystitis recurred 2 months later, likely due to the migrated stent. Stent removal was re-attempted using cholangioscopy (SpyGlass DS, Boston Scientific, USA; [ Fig. 2 ], [ Video 1​ ]). After advancing a guidewire into the gallbladder, the cholangioscope was guided along the wire by cholangioscopic visualization. The migrated stent was located, and its distal end was successfully grasped using a dedicated snare (SpySnare, Boston Scientific) passed through the cholangioscope. The stent was removed along with the cholangioscope, and a new 7-Fr double pigtail stent was deployed. Fig. 1 ( a ) A computed tomography image showing the migrated stent within the distended gallbladder lumen. ( b ) A fluoroscopic image during endoscopic retrograde cholangiopancreatography (ERCP) demonstrating complete stent migration into the gallbladder (yellow arrowheads). A hepatic artery infusion catheter is also noted (red arrowheads). ( c ) An ERCP image during attempted transpapillary retrieval showing unsuccessful extraction due to difficulty grasping the stent within the enlarged lumen. Fig. 2 ( a ) A cholangioscope was introduced into the cystic duct under fluoroscopic and endoscopic guidance. ( b ) The scope smoothly reached the gallbladder. ( c and d ) The migrated stent was visualized within the gallbladder, grasped with a dedicated snare under direct cholangioscopic visualization, and successfully removed. Video 1 Cholangioscopy enabled direct visualization and successful snare retrieval of a completely migrated gallbladder stent following endoscopic transpapillary gallbladder drainage, achieving safe and full removal without complications. Download Video In the reported case, cholangioscopy enabled the successful retrieval of a completely migrated gallbladder stent following ETGBD, demonstrating its effectiveness when conventional techniques failed. Endoscopy_UCTN_Code_TTT_1AR_2AL Publication History Received: 07 June 2026 Accepted after revision: 14 July 2026 Article published online: 29 July 2026 © 2026. 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/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany