Removal of an Uncovered Metal Stent from the Common Bile Duct Six Years after Implantation in Chronic Calcifying Pancreatitis

Standard therapy for benign stenoses of the biliary tract are coated metal stents or multi-stenting with plastic stents. Uncoated metal stents are not recommended because tissue ingrowth and overgrowth may render them impossible to remove with acceptable risk. We report a patient with chronic calcifying pancreatitis and cholestasis who, after unsuccessful multi-stenting with a total of 15 stent changes, was implanted with an uncoated metal stent in the common bile duct as second-line therapy. After this stent had been in place for six years and had to be balloon-cleaned 19 times during this time, the indication for removal came up. A fully coated metal stent of the same diameter but 2 cm longer was inserted into the lumen of the uncoated stent. It was left in place for 9 months and cleaned once during this time. Then, via ERCP, both stents were extended in a telescope-like manner, mobilized using a forceps and finally removed from the bile duct. Afterwards, the patient remained symptomless and free from cholestasis. The stent-in-stent technique for removing uncoated stents was first described for the esophagus. Our case shows that it can also be used in the biliary tract and even after an extended period of time.