A Novel Approach for Stent Removal After Migration

Date

2022

Authors

Sahu, Shweta
Roberts, Jay

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Background: Bariatric surgeries, including Roux-en-Y gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch, are becoming increasingly prevalent in not only the US, but in the world as a whole. Though rare, complications after bariatric surgery can occur, with the most feared complication being gastric/ anastamotic leaks. One well known, safe and efficacious treatment of these leaks includes the placement of self-expandable metal stents (SEMS). Unfortunately, these SEMS have been known to move to a location other than where they were originally placed, a phenomenon known as "stent migration." Case Presentation: A 33-year-old Caucasian female with morbid obesity presented to clinic to pursue Roux-en-Y gastric bypass surgery after numerous failed attempts to lose weight. Though she was asymptomatic at the time, the patient elected to pursue the surgical weight loss management option after a trial of medical treatment for obesity, in which she was unable to maintain the weight loss for an extended period of time. This, in conjunction with her growing risk of medical comorbidities associated with her pre-existing morbid obesity, determined the management with laparoscopic Roux-en-Y gastric bypass, which proceeded with no complications during the time of surgery. Nine months later, the patient presented with dysphagia and epigastric pain, which prompted the need for esophagogastroduodenoscopy (EGD) which revealed erosive gastritis and a large marginal ulcer traversing the anastomosis. Though the patient tolerated robotic revision of the gastrojejunostomy (GJ) well, she developed another gastric perforation that required placement of a 12mm x 24 mm SEMS in order to close the leak at the GJ anastomosis. The patient presented to clinic with discomfort yet again, and this time, imaging revealed the stent had migrated distally, and was located just proximal to the jejunostomy. A typical endoscope (approximately 2.5 feet in length) is not sufficiently long enough to reach this area, and thus a unique 2 surgeon approach was taken to retrieve the migrated stent using a colonoscope, typically 5 feet in length. Conclusion: This case illustrates an innovative approach to removing a distally migrated stent, a known complication of endoscopic stent placement in the management of gastric/ anastamotic leaks after bariatric surgery.

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