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Silent migration: unexpected finding at ERCP
  1. Sreelakshmi Kotha,
  2. Terry Wong,
  3. Philip Berry
  1. Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
  1. Correspondence to Dr Sreelakshmi Kotha,Guy's and Saint Thomas' Hospitals NHS Trust, London, UK; sreelakshmi_kotha{at}

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An elderly patient with a history of laparoscopic cholecystectomy presented with recurrent abdominal pain. Imaging revealed a dilated common bile duct (CBD) with filling defects. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated multiple linear metallic clips with a halo of calculus material (figure 1). Attempts at removing the clips following a 10 mm sphincteroplasty resulted in horizontal impaction of clips beneath the trawling balloon (figure 2), increasing the risk …

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