English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

A 77-year-old womanwith advanced pancreatic cancer presented with combined biliary and duodenal malignant obstruction. An uncovered self-expandable metal stent (SEMS) (Nexent Duodenal/Pyloric stent, 22mm×12cm; Next Biomedical, Korea) and a partially covered SEMS (Niti-S ComVi stent, 20mm×12 cm; Century Medical, Korea) were deployed for the duodenal obstruction (▶Fig. 1). After three cycles of chemotherapy, the two duodenal SEMSs had migrated to the transverse colon (▶Fig. 2). We decided to remove the SEMSs to avoid perforation. A short-type single-balloon enteroscope (SIF-H290S; Olympus Medical, Japan) was inserted with the overtube (▶Video 1). The SEMSs were identified at the bending part of the colon. We first tried to grasp the distal end with a rattooth forceps, but the SEMSs were tightly embedded in the wall. Therefore, the enteroscope was inserted across the SEMSs and the proximal end of the partially covered SEMS was grasped by the forceps and removed using the invagination method. The SEMSs and the enteroscope were pulled into the overtube so as not to injure the intestinal wall. Both SEMSs were successfully removed without any complications (▶Fig. 3, ▶Fig. 4, ▶Fig. 5; ▶Video 1). Several methods have been reported for removal of migrated enteral SEMSs [1– 4]. Most of these techniques are quite difficult when the distal end is located at the bending part of the colon. The invagination method has been reported to facilitate removal of an embedded biliary SEMS [5]. With this method, the proximal end of the SEMS is grasped with forceps and the SEMS removed by pulling it inside itself. This method could be useful when it is difficult to remove a SEMS from the distal end. It is important to lessen the risk of perforation by advancing the overtube near the SEMS, pulling the enteroscope and the SEMS into the overtube, and gradually, little by little, detaching the SEMS from the intestinal wall.

Endoscopic removal of two duodenal stents that had migrated into the colon, using the invagination method