Hello, we present a novel case of an esophageal stent retrieval. Esophageal stents are commonly used to treat refractory esophageal strictures, but these stents have a high rate of migration, and sometimes retrieval of these dislodged stents are very difficult. Our patient presented with dysphagia to solids and liquids. The upper endoscopy showed two strictures at 32 and 38 centimeters. The stricture was tight and could not be traversed with the adult gastroscope. Despite iterative balloon dilation, there was no response in his therapy. The CT scan showed a circumferential wall thickening of the esophagus. There were no mass lesions, and biopsies from the stricture were benign. A decision was made to place a fully covered esophageal stent. Proximal aspect of the stent was fixed with an over-the-scope clip, but on follow-up, the symptoms record. We did a repeat endoscopy, and it showed the stricture had record. Unfortunately, the stent had migrated distally and was noted to be in the stomach. To traverse the stricture, a new esophageal stent was placed. The stent was fixed with over-the-scope clip, and we initially tried to go through the stent with the adult gastroscope, but the scope could not traverse the stricture. It was replaced with a pediatric scope, and as you see here, the stent was in the stomach. Using moray microbiopsy forceps, we tried to grasp the distal end of the dislodged stent, and the idea was to pull the stent through the newly placed stent, and then retrieve it back. The microbiopsy forceps could exert only that much force on it, and we were able to bring it back inside the stent. As you see, this is the over-the-scope clip of the dislodged stent. Several attempts were made to grab the stent back inside the stent, and in the retroflex view, we tried to grab the distal-most thread on the esophageal stent, and then using maximum torsion, we pulled the stent back inside the new stent. As you see here, the old stent is now placed inside the new stent, but we could not pull it through this using the moray forceps, so we switched again to an adult scope, and using normal grasping forceps, or rat-tooth forceps, we tried to pull the old stent through the new stent. The biggest risk here was we were trying not to pull the new stent along with the old stent and only gentle pressure was exerted. So with this, we were now able to reach to the proximal end of the new stent. And as we were pulling the stent through, the stent unfortunately got stuck at the upper esophageal sphincter. We went in and again using the grasping forceps, the stent was pulled out. To confirm that the new placed stent is still there, we went back in and as you can see the stent was patent and its position was confirmed. A second over the scope clip was placed to fix the stent in position. On follow up, the new stent had migrated proximally but it was still patent and had a lot of food debris on it. We were able to traverse the stent and the structure with the adult scope. So the stent was now removed. To conclude, esophageal stents have a high risk of migration despite the use of over the scope clip. The lost stents can be retrieved using this technique that we just showed through a newly placed stent and the newly placed stent can still remain in place after the old stent was removed. Use of micro forceps through the pediatric gastroscope is a feasible method for stent retrieval. The risk of migration should definitely be discussed with the patients before the procedure is started. Thank you.

esophageal stent retrieval

migration issues

dysphagia

strictures

micro forceps