A young patient was scheduled for the removal of a covered metallic stent (cSEMS) from the Common Bile Duct (CBD), which had been placed nine months earlier. The first removal attempt failed due to significant stent ingrowth. During the second attempt, a critical error occurred: the special grasping forceps got stuck, and its internal wire core broke off, leaving the closed forceps tip trapped inside the stent mesh. When we tried to free the trapped forceps with a Dormia basket, the basket also got stuck. This created a complex, multi-layered metal blockage deep in the CBD, a situation that usually means immediate surgery is necessary.

To solve this unusual and severe problem without surgery, we used a non-standard method. We decided to use bipolar fragmentation forceps, which are usually designed to cut other large metal structures. The technique involved using the bipolar current to cut the metal parts of the stuck instruments (the forceps shaft and the basket wires). The goal was to dismantle these instruments in the distal CBD, showing an innovative and highly unusual way to use this specialized tool for a major mechanical failure.

The bipolar cutting technique worked technically: we successfully cut the metallic parts. The core of the broken forceps and all the stuck Dormia basket wires were cut near the main bile duct opening (papilla of Vater). However, the smaller, cut metal fragments of both instruments remained firmly trapped inside the deeply ingrown stent mesh. Following these complications and the partial endoscopic result, we decided to stop the procedure and plan for a definite surgical repair later.

Our case shows that specialized bipolar fragmentation forceps have high potential for dealing with very unusual and difficult complications, like having metal instruments stuck in a critical area. This highlights that successful advanced endoscopy sometimes requires creative, "out-of-the-box" thinking and using existing tools in new ways. The remaining metal fragments show the limit of this technique, especially when the main problem is a deeply ingrown stent. We believe that adding a scope for direct viewing inside the bile duct (cholangioscopy) could significantly help manage such deeply ingrown stents in the future.