EP542 - ERCP removal of self-expanding metal stent (SEMS) after 25 months

Abstract This abstract highlights a less-explored complication associated with Endoscopic Retrograde Cholangiopancreatography (ERCP) – the delayed removal of pancreatic or biliary stents. The case study involves a 45-year-old woman with a Self-Expandable Metal Stent (SEMS) in place for an extended period of 2 years. Initially, the patient sought medical attention due to episodic epigastric pain, revealing gallstones partially obstructing the common bile duct. An initial ERCP aimed to extract the stones, but a large stone proved challenging to remove. Subsequently, a temporary Fully Covered Self-Expandable Metal Stent (FC-SEMS) was inserted. A follow-up ERCP was planned to remove both the stone and the stent. However, the patient experienced intolerability during the procedure and developed post-ERCP pancreatitis, leading her to decline the second ERCP. In the following year, the patient faced transient common bile duct (CBD) blockage and ascending cholangitis episodes. After thorough discussion with the medical team, she consented to a second ERCP. During this procedure, it was discovered that the SEMS had ingrowth of duodenal mucosa at the proximal end. Successfully removing the SEMS and stone required using a needle knife to dissect the duodenal mucosa of the stent and flipping the stent inside out, as the tissue around the stent was challenging to access. This case underscores the challenges and risks associated with prolonged stent retention. The abstract strongly recommends against leaving the stent in place for an extended duration and advocates for attempting stent removal through ERCP before considering a surgical approach.