Two-step approach: Stone extraction after covered stent placement in Mirizzi syndrome: Early experience from a retrospective study

BACKGROUNDMirizzi syndrome is characterized by large impacted stones and concomitant relative stenosis of the distal bile duct, and its management poses significant clinical challenges.The optimal endoscopic therapeutic strategy for this condition remains a subject of active debate in clinical practice.AIM To investigate endoscopic therapeutic approaches for Mirizzi syndrome.METHODS This was a retrospective, non-controlled, observational study conducted at Renji Hospital, School of Medicine, Shanghai Jiao Tong University.All patients were diagnosed with Mirizzi syndrome and underwent stone extraction after fully covered stent placement between June 2021 and June 2025.Step 1: A fully covered stent was left in the biliary tract for approximately 8 weeks to expand the narrowed bile duct.Step 2: Stent removal and stone extraction using balloons, basket catheters, or electrohydraulic lithotripsy.RESULTS A total of 23 patients (14 females, 9 males; median age 69 years) underwent two-step stent-assisted stone extraction.Fully covered stents were successfully implanted in 23 patients with a median dwell time of 63 days.The stone extraction success rate was 82.6% (19/23) and the median stone extraction time was 21.5 minutes.Five cases of cholecystitis and three cases of pancreatitis were reported.CONCLUSION 4 / 19To our knowledge, this is the first study to evaluate the feasibility and safety of stone extraction after covered stent placement in patients with Mirizzi syndrome.Stone extraction after covered stenting is a viable option for Mirizzi syndrome, particularly in patients unsuitable for prolonged endoscopic retrograde cholangiopancreatography or those with marked distal bile duct stenosis.