Removing an Occluded Biliary Stent Utilizing Argon Plasma Laser

Stent occlusion is a well-known complication in patients needing decompression of the biliary tract, and it requires active intervention to prevent progression to cholangitis and further sepsis. Occlusion due to in-stent growth can occur particularly in the cases of uncovered stents. We report a rare case of an 83-year-old male who developed obstructive jaundice due to a pancreatic adenoma, which was managed with an uncovered stent in the biliary tract. Occlusion of an uncovered expandable metallic stent [EMS] led to placement of a covered stent within the uncovered stent. This again occluded, which required extraction of the covered stents along with the overlying uncovered EMS. An argon plasma laser was used to dissect the ingrown tissue between the uncovered EMS and the wall of the biliary duct while pulling with rat forceps. This was technically challenging given the presence of a second stent within the first stent, which was covered and rather easier to extract, delineating the differences between the two. It was quite evident why covered stents are more prone to migration, whereas uncovered ones are prone to in-stent growth, especially with malignancies leading to occlusion. No surgery-related complications occurred, and the patient developed normalization of the liver function test.