A Novel Technique for Redeployment of a Migrated Enteral Self-Expandable Metallic Stent in Malignant Gastric Outlet Obstruction

Abstract

Migration of enteral self-expandable metal stents (SEMS) is a recognized adverse event during palliation of malignant gastric outlet obstruction (GOO). A 49-year-old male with metastatic pancreatic adenocarcinoma with GOO underwent enteral SEMS placement, which migrated distally by the next day. Conventional repositioning attempts resulted in complete proximal migration of the SEMS into the stomach. Given the patient's general condition, terminally ill status, and cost considerations, we adopted a novel technique for SEMS redeployment. Initially, the migrated SEMS was retrieved using foreign body forceps. A SEMS was loaded onto an endoscope fitted with the bare cylinder of multiband ligator at the tip. We secured the distal end of the SEMS to the cylinder with a looping snare. Under combined endoscopic and fluoroscopic guidance, we advanced the SEMS-snare-endoscope assembly into the duodenum across the stricture. After confirming the stent's position across the stricture, we disengaged the snare from the SEMS and carefully withdrew the snare and endoscope. The procedure was technically successful, with adequate luminal patency achieved. No immediate adverse events were observed. The patient reported symptomatic relief and improved oral intake. This snare-assisted redeployment technique using a multiband ligator cylinder offers a feasible, safe, and cost-effective salvage option in selected palliative patients.