Demonstrates successful endoscopic removal of biliary coils in an elderly patient, highlighting its clinical value.
Embolization coil migration into the common bile duct (CBD) is an extremely rare complication of transcatheter arterial embolization.[ 1 ] While coil migration into the intestinal lumen has been managed conservatively,[ 2 ] surgically,[ 3 ] or endoscopically,[ 4 ] [ 5 ] optimal treatment for biliary migration remains unclear. Specifically, although endoscopic retrograde cholangiopancreatography (ERCP) with cholangioscopy is recommended for biliary foreign bodies, successful endoscopic management for migrated coils especially those partially wall-embedded remains poorly reported, with unclear bleeding and perforation risks. A 76-year-old man was admitted with persistent right upper quadrant colicky pain and vomiting. Computed tomography demonstrated extrahepatic bile duct dilation, duct wall opacification, and surrounding radial metallic artifacts. One year earlier, he had hemobilia post-choledocholithotomy; angiography revealed supraduodenal artery bleeding with pseudoaneurysm, treated with four coils. Thus, coil migration was presumed; a multidisciplinary team discussion was held due to rarity, and ERCP with peroral cholangioscopy (POC) was planned ([ Video 1 ]) as he refused surgery. Intraoperatively, cholangiography showed a dilated CBD with a 3.0×1.5 cm mobile filling defect containing a wire-like material ([ Fig. 1 ]). POC identified multiple choledocholiths ([ Fig. 2 ]); lower CBD mucosa was rough and hyperemic, with two biopsies taken. Over 28 minutes, repeated interventions (lithotripsy with dormia basket, balloon disimpaction, and forceps retrievals via POC) successfully removed the foreign bodies ([ Fig. 3 ]). Postoperatively, he had mild abdominal pain and transient hyperamylasemia, improving rapidly and discharged. Pathology showed active chronic cholangitis ([ Fig. 4 ]). At 5-month follow-up, he remained asymptomatic. Video. 1 Procedure of the endoscopic removal of the coils migrated from the vasculature into the common bile duct. Download Video Fig. 1 The oval filling defect and internal wire-like material under ERCP. Fig. 2 Choledocholiths with mucosal irregularity and hyperemia in the lower common bile duct under a peroral cholangioscope. Fig. 3 Extracted stone fragments and wire-like materials. Fig. 4 Pathology of common bile duct mucosa demonstrating active chronic cholangitis with partial mucosal degeneration and necrosis. Here, we present the successful endoscopic removal of CBD coil migration using peroral cholangioscopy for direct visualization, biopsy, and precise retrieval. This minimally invasive, cost-effective approach benefited this elderly, high-surgical-risk patient without the need for surgery, supporting its safety and clinical value. Endoscopy_UCTN_Code_TTT_1AR_2AK Publication History Received: 01 July 2026 Accepted after revision: 11 July 2026 Article published online: 07 August 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
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