Minimally Invasive Retrieval of a Migrated Duodenal Stent

Case Report

Gastrointest Cancer Res Ther. 2016; 1(1): 1004.

Minimally Invasive Retrieval of a Migrated Duodenal Stent

Edwards SB¹, Steele J², Iskandar M², Wayne M² and Cooperman AM²*

¹Department of Surgery, Mount Sinai Beth Israel, USA

²Division of Surgical Oncology, Mount Sinai Beth Israel, USA

*Corresponding author: Avram M Cooperman, Division of Surgical Oncology, The Pancreas & Biliary Center at Mount Sinai-Beth Israel Medical Center, 10 Union Square East (2M), New York, New York 10003, USA

Received: June 17, 2016; Accepted: July 01, 2016; Published: July 04, 2016


Background: Self-expanding metal and covered metal stents (SEMS) commonly relieve malignant gastric outlet obstruction. In benign disease their use is limited. While disease progression and tumor ingrowth limit migration of duodenal stents in malignancy, stents placed for benign disease are more likely to migrate. When needed, laparotomy has been used to retrieve migrated stents. We summarize a case and the rationale for laparoscopic stent retrieval.

Methods: A 62 year old female had a coated metal duodenal stent placed endoscopically after failure of medical management for a duodenal stricture secondary to peptic ulcer disease. This stent migrated and impacted in the mid jejunum and could not be retrieved endoscopically. Laparoscopic retrieval was successful and without complication

Results: Oral intake was resumed on postoperative day 4. No intraoperative or postoperative complications occurred.

Conclusions: Laparoscopic retrieval of a migrated duodenal stent is a safe and feasible approach, and should be considered when migrated, symptomatic stents are beyond the reach of endoscopes and warrant retrieval.

Keywords: Small bowel obstruction; Gastric outlet obstruction; Duodenal stent; Self-expanding metal stents; SEMS; Stent migration; Bowel perforation


SEMS: Self-expanding metal stent; GERD: Gastroesophageal Reflux Disease; GOO: Gastric Outlet Obstruction


Self-expanding metal and covered metal stents (SEMS) are used to relieve malignant gastric outlet obstruction. Their use in benign disease is limited. The incidence of stent migration in benign disease ranges from two to fifty plus percent [1,2]. While most migrated stents pass spontaneously or are retrieved endoscopically, four to seven percent require surgical removal. We report a case of laparoscopic stent retrieval and advocate that a minimally invasive approach be considered for migrated stents causing small bowel obstruction.

Case Presentation

A 62 year old female with a history of hypertension, diabetes and Gastroesophageal Reflux Disease (GERD) presented to the emergency department five weeks after hysterectomy with intractable nausea and vomiting. Upper endoscopy showed gastric outlet obstruction (GOO) secondary to duodenal ulceration and was treated with a proton-pump inhibitor (Image 1). Endoscopic evaluation 1 month later showed a stricture of the duodenum and a 22mmx10cm coated metal stent was deployed (Image 2). She was discharged on a puree diet and proton-pump inhibitor with planned stent removal in 6-8 weeks.